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Anxiety is something everyone experiences from time to time. It involves different thoughts and behaviours that can occur in response to a possible threat. Anxiety itself isn’t bad. In fact, it’s an important emotional and physical experience that can protect people from harm.
Anxiety can vary in strength, from mild to very severe. It can pass quickly or last a long time. It can be triggered by many situations, including social settings, performances or speeches, crowds, deadlines, health problems, or threats to safety and wellbeing.
Most people experience anxiety at some point in their life. It’s also a common symptom of many mental health issues. A variety of anxiety disorders have been identified. Some of the most common anxiety disorders include generalised anxiety disorder, panic disorder (panic attacks), and social anxiety disorder.
Anxiety can involve symptoms like1:
Some people experience anxiety for their whole life and don’t know what it feels like to live without anxiety – it feels normal to be worried and on edge. But living with chronic anxiety can cause long term impacts. These include increased risk of physical health issues, such as headaches, nausea, immune system problems, heart problems, and stomach problems.
Anxiety will feel different from person to person. Genetic factors and life experiences can impact both how serious a person's anxiety is, and what it feels like for them2.
Part of what creates anxiety is the body's normal reaction to a perceived threat – the fight or flight response. The fight or flight response involves the body preparing for action. By increasing heart rate, muscle tension and fast breathing, bodies prepare to either fight or escape danger.
Though helpful for keeping people safe, these responses can feel overwhelming and confusing. Especially when it occurs when a person is not actually in danger, but going about everyday life.
Some people strategies like these are helpful to prevent, manage, or reduce their anxiety:
Not everybody who experiences anxiety needs mental health support. For many people, anxiety is a temporary experience, or mild enough to not cause problems.
But many people do find treatment and support helpful.
It’s a good idea to talk to a GP first. A GP can provide information and referrals for other health professionals or support services.
Here are some psychological therapies that have been found to be helpful for managing anxiety disorders3:
Some people also find medication helpful to manage their anxiety, particularly if it is severe or ongoing3
Anxiety is a normal part of life, but there are things you can do to help manage it if it is causing problems. To connect with others who get it, visit our online Forums. They’re safe, anonymous and available 24/7.
1. American Psychiatric Association. Diagnostic and statistical manual of mental disorders (5th ed.; DSM-5). In: 5th ed. American Psychiatric Association; 2013.
2. Gottschalk MG, Domschke K. Genetics of generalized anxiety disorder and related traits. Dialogues in clinical neuroscience. 2017 Jun;19(2):159–68.
3. Bandelow B, Reitt M, Röver C, Michaelis S, Görlich Y, Wedekind D. Efficacy of treatments for anxiety disorders: a meta-analysis. International clinical psychopharmacology. 2015;30(4):183–92.
www.sane.org
Helpline 1800 187 263
It’s natural to worry during the stressful times we all experience from time to time in life. Someone with an anxiety or related disorder, however, feels persistently anxious in a way which is excessive and out of keeping with the situation they are in.
Understanding how anxiety disorders ‘work’ then, is an important first step in taking control of symptoms and getting better.
Anxiety disorders are thought to be caused by a combination of factors. Most anxious people are probably born with a genetic vulnerability to develop an anxiety disorder. Personality traits and responses to stressful life events may trigger the condition or make it worse.
Common stressful life events include:
When someone has an anxiety disorder, the worry and discomfort they experience is persistent (lasting six months or longer). It can express itself physically as well as psychologically, and also affect behaviour.
These changes in how someone feels, thinks, and acts can then start to interfere with their ability to live a normal life, to work, and to relate to other people.
Anxiety disorders vary and affect people in different ways and to different degrees, but common psychological symptoms include:
Anxious thoughts and feelings can lead to physical responses too, as the body reacts to the ‘false alarm’ of anxiety. It goes into ‘flight or fight’ mode, as though you were in real danger and had to act fast:
These physical symptoms can sometimes occur without awareness that they are associated with anxiety.
It’s understandable that people will change their behaviour to try to avoid distressing symptoms of Anxiety disorders. This can then start to have an impact on their lives.
Someone with a Social anxiety disorder, for example, will avoid situations where other people are present. This can lead to them having no social life, experiencing great loneliness, and even stopping them from working.
Anxiety disorders are often accompanied by depression, so that both will need to be treated – see Depression).
People who experience psychotic symptoms such as delusions and hallucinations – such as those with schizophrenia, for example – may also experience symptoms of an anxiety disorder – see Bipolar disorder and Schizophrenia.
Each person’s experience of an Anxiety disorder can be very individual, but common forms include:
GAD is characterised by persistent worry that the person realises is excessive or unrealistic. It can be about almost anything – money, work, health, relationships or being harmed.
People affected by GAD often worry and ruminate over everyday events in their life, until these assume a significance out of proportion to reality.
Constantly reacting to fearful thoughts and feelings, they may often feel irritable, nervy, and haunted by a sense of unease and dread. Sleeping problems are also common.
People may drink alcohol excessively in order to ‘take the edge’ off this sense of general anxiety.
Phobias are intense, irrational fears about specific objects or situations – for example, a fear of heights, storms, dogs, enclosed spaces, snakes or spiders where the danger is greatly overestimated.
Many people affected try to cope by avoiding the feared objects or situations. They may not recognise that they have an anxiety disorder. These fears can interfere with a person’s life, and can occur when someone has another form of anxiety disorder too.
Panic disorder involves frequent sudden attacks of intense fear (panic attacks). These may occur when a person feels ‘trapped’. They may even feel as if they are about to die.
When someone experiences panic they may feel breathless, dizzy, choking, or faint. They may feel their heart pounding. It is common for people to believe that these symptoms are caused by a serious physical condition such as a heart attack or stroke.
Because these physical symptoms are distressing and frightening, the person experiencing them becomes even more anxious and fearful of ‘triggering’ them. They may start to avoid situations associated with feelings of panic, or in which they feel they could not escape or get help – such as on public transport, in crowded places, or being completely alone.
Social anxiety disorder involves intense anxiety associated with social situations, such that the person’s ability to live a normal life is affected. There is an intense fear of embarrassing oneself in public or being scrutinised by others.
This anxiety can lead to physical symptoms such as blushing, sweating, shaking and heart pounding, which in themselves can cause embarrassment.
Social anxiety disorder may initially occur in only certain situations (such as public speaking or large gatherings), but it can spread to involve any type of social interaction.
Those affected often react by becoming withdrawn or avoiding social situations, or by drinking alcohol excessively when attending them, which can lead to further problems.
Anxiety disorders are closely related to three other types of disorders
Anxiety disorders are closely related to Obsessive compulsive and related disorder (OCD), Hoarding disorder and Trauma and stress-related disorders. It is not uncommon for people with these conditions to experience symptoms of anxiety.
OCD is characterised by intrusive thoughts about unpleasant things that might happen. OCD is highly distressing for the person experiencing it and for those who care about them.
Common concerns include fear of contamination from germs, intrusive sexual thoughts, fears about leaving doors unlocked or appliances turned on, and fears of violence or causing harm to others.
The person may feel compelled to ritually check, clean, or count. They may avoid situations where their fears might be triggered or where they don’t feel they can trust themselves.
Hoarding disorder is characterised by a persistent difficulty discarding or parting with possessions due to a perceived need to save the item, regardless of its actual value. The person may experience significant distress and anxiety if and when they try to discard the items that they have collected.
Trauma and stress related disorders follow a traumatic event which causes intense fear or feelings of helplessness. Witnessing a traumatic event directly or indirectly can also lead to this condition.
The symptoms typically develop shortly after the event, although it may take years before they develop. Symptoms include re-experiencing the trauma through nightmares, rumination, and flashbacks.
People affected may avoid situations, people, and objects which remind them of the traumatic event. For example, after a serious car accident, someone might avoid driving or being a passenger in a car.
There is also increased anxiety in general and the person may become very jumpy and startled easily. Some people find themselves less emotionally responsive to others, describing themselves as feeling emotionally ‘numb’.
Treatment for an anxiety disorder doesn’t just deal with immediate symptoms. It also helps tackle the triggers for symptoms and other contributing factors. You learn to control the anxiety so its effect on your life is reduced or even eliminated.
With treatment you will feel better mentally, emotionally, and physically.
A General Practitioner (GP) is the best person to see if you are concerned you may have an Anxiety disorder.
Ask for a longer appointment so there is time to discuss your concerns. It helps to take along a few written notes too. The GP can check first for any possible physical cause of the symptoms, such as thyroid disease or low glucose, for example.
If the GP diagnoses an anxiety or related disorder, a mental health plan can be prescribed, usually involving a course of psychological treatment. This may be provided by the GP or through a referral to another suitably-qualified health professional.
Psychiatrists are medically-qualified doctors who specialise in the study and treatment of mental illnesses, including Anxiety disorders.
For further information, please see the ‘Psychological treatments’ section in the Guide to Medication and other Treatments.
Clinical and counselling psychologists specialise in the treatment of mental illnesses, including Anxiety disorders. They can provide psychological treatments, which are usually the most effective treatments for Anxiety disorders.
For further information, please see the ‘Psychological treatments’ section in the Guide to Medication and other Treatments.
Psychological treatments play a vital role in the treatment of people with Anxiety disorders. This type of treatment helps by giving an opportunity to talk about thoughts and feelings with a psychiatrist, psychologist or other suitably-qualified health professional in a structured way.
There is a range of psychological treatments for Anxiety disorders, of which cognitive behavioural therapy is one of the most effective for managing symptoms. Other forms of psychotherapy may also be of value in dealing with related issues.
CBT helps people recognise how their thoughts, feelings and behaviour can get stuck in unhelpful patterns. It supports people in trying new ways of thinking and behaving.
The steps are:
1.The first step is to agree on the goals of the treatment. Therapy then begins with an explanation of how anxiety can cause the symptoms, and what strategies can be used to manage them.
2.The person will then be taught some techniques to help control the symptoms, and asked to practise these at home.
3.The next step is learning not to fear the symptoms of anxiety. The therapist and the person affected work together to decide on tasks that the person can try outside, as well as within, the sessions, to confront and overcome their fears and anxieties.
It is usual to take a step-by-step approach rather than ask someone to confront these concerns all at once.
A course of CBT usually consists of 10-15 weekly sessions that last for up to one hour each.
For further information, please see the ‘Psychological treatments’ section in the Guide to Medication and other Treatments.
There is a range of online resources to help people manage the symptoms of anxiety. See the Australian government’s mindhealthconnect website for an up-to-date list of reputable and helpful websites - www.mindhealthconnect.org.au
While psychotherapy is the most effective treatment for managing the symptoms of Anxiety disorders, medication may also helpful for some people where symptoms are severe or persistent or where there is a co-existing condition such as depression.
Medication may also help temporarily to reduce anxiety when beginning a course of psychotherapy, to make it easier to get started.
There are many different types of antidepressant medication available. Choosing the best one is not always straightforward because the way individuals respond to them is different.
Discuss with your doctor whether medication would be helpful for you – considering your particular symptoms of anxiety, any other conditions and symptoms you have (including physical illnesses), and how this would complement any psychotherapy you might be receiving.
Be sure to tell the doctor if you are pregnant or planning a pregnancy, and also about any herbal or other complementary remedies you are taking, as these may interact with the medication prescribed.
It can take a few weeks after the first dose of medication before it has a positive effect. For some people it can take longer – a few months – before they start to feel better. It can be six months before the maximum benefit is felt.
Antidepressants are not addictive and do not act as ‘uppers’. Newer antidepressants are generally not fatal in overdose.
For further information, please see the ‘Medication’ section of the Guide to Medication and other Treatments
The possible side-effects of antidepressants
As with any other medications, antidepressants may have side-effects. These will often settle down after a few weeks, when your body has adapted to the medication, while others may persist.
Possible side-effects include:
Let your doctor know as soon as possible if you experience and are concerned about any of these side-effects.
The doctor can provide reassurance and change the dosage if necessary. The medication can also be changed to one which is more effective for you, or has fewer side-effects. Because our bodies’ reactions are so individual, this is common, normal part of the treatment process.
It’s a good idea to tell family or friends about the medication, its benefits, and any side-effects, too, so that they can support you.
These medications are sometimes prescribed as a short-term treatment for symptoms of anxiety disorders when symptoms are severe.
They may be prescribed in addition to an antidepressant, while waiting for it to take effect. These can provide immediate and short-term relief of the symptoms of anxiety or insomnia, but don’t treat the underlying condition that causes the Anxiety disorder.
Long-term use is generally not recommended as they also cause drowsiness, can be addictive, and symptoms usually return once someone stops taking them.
For further information, please see the Guide to Medication and other Treatments.
There are lots of things you can do for yourself to help reduce feelings of stress and anxiety.
The experience of having an Anxiety disorder varies from person to person. While managing symptoms can often be difficult, and this should not be underestimated, discuss with your treating health professional what you can do to help yourself.
The more we understand about Anxiety disorders, the better prepared we are to start dealing with them. Understanding the symptoms, causes, and symptoms of anxiety can help us to tackle it better.
Many anxious people feel a strong need to ‘know for sure’ about situations or about the future. This often just isn’t possible.
Do what you can to accept that things often are uncertain, and to ‘wait and see’.
Many people affected by Anxiety disorders find it helpful to meet and talk with others who have had similar experiences.
Discussing symptoms and tips for dealing with them in a relaxed, understanding environment such as this can be a great support in recovery from anxiety. Contact 1800 18 SANE (7263) or the SANE Online Helpline for details of a group in your area, or find on online community at www.mindhealthconnect.org.au.
As someone starts to feel extremely anxious they often experience a similar pattern of warning signs – symptoms such as feeling on edge or becoming short of breath. Emotions and physical responses react as though there were real danger – but this is the big lie of anxiety disorders, for ‘everything is not an emergency’.
Learn to recognise the warning signs, so you can re-assess your situation and try to nip the anxiety in the bud.
Think about what happens when you start to feel anxious. If you often feel like you are going to have a panic attack on public transport, for example, make a list of how you feel and what happens to your body when this happens.
Alongside this, make a list of how you could manage these symptoms – such as slow breathing or thinking about something very positive, for example.
You probably already have some healthy ways of helping yourself feel less anxious. Recognise and build on these.
For example, every time you find yourself slipping into a spiral of worry over a past event or something that might happen in the future, tell yourself to stop and focus on the here-and-now, on enjoying being immersed in the present moment.
Some people find it helpful to have a mantra (a helpful, inspiring phrase) or powerful mental image to help them do this: for example, imagining their life as a vast sphere and the worry as a tiny speck beside it.
When you feel anxious it can seem like there’s no way out from problems that trouble you. Try to take a fresh approach which helps you look at the problem from a different angle, so that stress and worry can be reduced.
If something is troubling you, try not to dwell on it but write it down in black-and-white, then put down all the different ways you could tackle it. Consider which is the most realistic and useful, and what practical steps you could take to carry it out. Discuss these with your health professional.
It’s likely your GP, psychologist or other treating professional will talk to you about breathing slowly as a way of dealing with anxiety. This can be a surprisingly simple and effective way of helping your body relax and switch off the tense ‘flight or fight’ emergency response which anxiety triggers.
Take a slow breath in for six seconds, hold it briefly, then breathe out slowly. Don’t rush the breaths, and repeat for a minute or so.
Our physical and mental health interact continually. Getting enough sleep, eating healthy meals, and avoiding recreational drugs and excessive alcohol not only does your body good, but will make you feel good too.
Too much caffeine can contribute to feeling anxious, so try reducing or even giving up coffee or other drinks which contain caffeine.
Physical exercise is also a proven way of improving mood, probably because of healthy changes this brings about in the body and brain. This doesn’t have to mean going to a gym, but can be something as simple as riding a bicycle to work or taking a brisk walk for half-an-hour or more a few times a week.
For further information, please see the Guide to Healthy Living.
Make time every week to do things you enjoy and which relax you. Going for a walk, having a massage, listening to music or simply immersing yourself in reading or watching a movie can help calm you and reduce anxiety.
People affected by Anxiety disorders are often hyper-alert a lot of the time, so it’s good to deliberately tell yourself that your mind and body are ‘off duty’ and have a right to relax.
Try to develop a habit of being flexible rather than over-demanding on yourself or others. Don’t try too hard to be perfect in everything you do.
Remember that you’ll never be able to control everything that happens around you, or what other people do and think, so why not accept this and concentrate on enjoying just being yourself.
If a family member or friend is affected by an anxiety disorder, talk to your GP or other health professional about where you can find out more about anxiety disorders, and about support for yourself as well as the person affected.
Family and friends can make a big difference to the lives of people affected by anxiety, but you have to make sure you look after your own mental health as well.
Don’t forget that being a good support person means getting support for yourself too.
This may mean mutual carer support online or by attending a group of others who are in the same situation; education and training in looking after yourself as well as the person with the Anxiety disorder, and finding respite care too so you can take a break.
When someone you care about becomes unwell, it is not only their situation that changes – it affects you too.
Try not to pretend to yourself or others that things haven’t changed. Express your feelings and find out more about how you can adapt to helping the person affected.
Sometimes getting better can feel overwhelming to the person affected. Encourage them to break things into manageable steps, so that gradual progress can be made.
For example, if you are encouraging someone to get out of the house regularly, you could offer to go with them on walks. You might start with walking around the block slowly together at a quiet time of day, and then work on varying the time and going for longer distances.
Reducing symptoms of Anxiety disorders can often be a long-term project.
It is important to accept the person as they are now, and to have sensible expectations of what can be achieved and how long it may take.
Learning more about the disorder and about treatments helps to develop realistic expectations about this process.