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What is Anxiety?

Anxiety is a natural and complex emotion that involves a combination of feelings, including fear, unease, worry, and apprehension. In humans, anxiety can be understood in terms of its physiological, cognitive, emotional, and behavioral components:

  • Physiological Response: This involves the body's automatic and immediate response to danger or threat, often referred to as the "fight or flight" response. Physical symptoms can include a rapid heartbeat, increased blood pressure, sweating, trembling, dry mouth, and stomach upset.

  • Cognitive Component: This relates to the thoughts or beliefs that are associated with feelings of anxiety. An individual might constantly think about the worst-case scenario or perceive situations as more threatening than they actually are.

  • Emotional Component: This encompasses feelings of tension, nervousness, dread, unease, or panic.

  • Behavioral Response: This includes the actions people take in response to their feelings of anxiety. For instance, avoiding certain places or situations, seeking reassurance, or escaping the situation.

Anxiety is a natural reaction to stress and can be beneficial in some situations. For instance, it can alert us to dangers and help us prepare and pay attention. However, for some people, anxiety can become overwhelming and debilitating, interfering with their daily activities.

The causes of anxiety and anxiety disorders can be multifaceted, including genetic factors, brain chemistry, personality, and life events. Treatments can involve a combination of therapy, medication, lifestyle changes, and other strategies. If someone believes they are suffering from an anxiety disorder, they should consult with a mental health professional.

Symptoms and Psychological Treatment of Anxiety

Very few psychological problems cause more distress than anxiety. Often, the symptoms develop over time and the individual may not be aware of the anxiety as an ongoing problem. Anxiety causes a range of psychological as well as physical symptoms. These can vary between individuals, however, psychological symptoms often include:

  • excessive worries
  • exclusive focus on one particular topic
  • lack of concentration
  • irritability
  • restlessness
  • social withdrawal
  • avoidance of locations or individuals
  • hopelessness
  • disturbances to memory and attention
  • negative thinking ("There is no easy way out")

In addition, physical symptoms are possible including

  • feeling hot
  • feeling unsteady
  • heart pounding or racing
  • feeling dizzy
  • hands trembling
  • difficulty in breathing
  • a feeling of choking
  • indigestion
  • lightheadedness
  • hot and cold sweats

Not everybody experiences all of these symptoms and they may change over time. Individuals with phobias (fear of a specific object or situation) may feel anxious when approaching the particular object or situation. Examples of specific phobias are

  • a fear of certain animals
  • concerns about a particular medical procedure (e.g. an injection)
  • a fear of flying (e.g. air travel)
  • being uncomfortable in open places
  • being uncomfortable in narrow/enclosed locations
  • a fear of acceleration (e.g. in an elevator)
  • a fear of public places

Individuals with social anxiety (or phobia) often avoid social groups and situations as well as meeting new people. It is important to distinguish social anxiety from neuro-developmental disorders such as Autism Spectrum Disorder (ASD), including Aspergers, and social (pragmatic) communication disorder. These neuro-developmental disorders make social communication difficult or may delay the devlopment of social skills.

What are Anxiety Disorders?

Anxiety disorders are common in children (and adults), with prevalence estimates ranging from 5% to 25% in different countries. Anxiety disorders often co-occur with mood disorders and can result in depression or other mental health problems such as substance use. Early onset anxiety disorders (13 years or younger) may follow a chronic course and, hence, an early diagnosis is important.

Cognitive-behavioural models of anxiety disorders suggest that negative automatic thoughts play a significant role. Hence, Cognitive Behavioural Therapy (CBT) strategies have been developed, which include cognitive restructuring, coping self-talk, in vivo exposure, modelling and relaxation training. The effectiveness of CBT can be further enhanced through the addition of family therapy. The authors report that negative automatic thoughts and anxiety control (the feeling to be in control of symptoms) make unique contributions to treatment outcome. The influence of both automatic thoughts and anxiety control appeared to differ across various types of anxiety disorders.

Types of Anxiety Disorders

If anxiety reaches a point where it becomes chronic and interferes with daily life, it might be classified as an anxiety disorder. There are several types of anxiety disorders, including:

  • Generalized Anxiety Disorder (GAD): Chronic anxiety, exaggerated worry, and tension, even when there's little or nothing to provoke it.

  • Panic Disorder: Characterized by unexpected and repeated episodes of intense fear accompanied by physical symptoms like chest pain, heart palpitations, or shortness of breath.

  • Social Anxiety Disorder (Social Phobia): Overwhelming anxiety and excessive self-consciousness in everyday social situations.

  • Specific Phobias: Intense fear of a specific object or situation, such as heights or flying.

  • Obsessive-Compulsive Disorder (OCD): Repeated, intrusive and unwanted thoughts or rituals that seem impossible to control.

  • Post-Traumatic Stress Disorder (PTSD): Can develop after exposure to a terrifying event in which physical harm occurred or was threatened.

  • Separation Anxiety Disorder: Common in children, it is an excessive anxiety concerning separation from home or from those to whom the individual has a strong emotional attachment.

What are the Psychological Treatment Options?

CBT is long established as a method of choice for anxiety and depression in children. Negative automatic thoughts play a role in symptoms of anxiety disorder. The individual may make false or immature predictions about what can happen in the absence of care-givers or partners. Alternatively, the individual may rehearse in his or her mind what might happen to attachment figures during periods of absence, which could lead to an indefinite separation. The individual may also “catastrophise”, that is, interpret minor events in the absence of parents or partners as very negative and, as a result, experience intense fear.

How does Cognitive Behavioural Therapy work? CBT addresses distorted and unhelpful patterns of thinking that result in anxiety. Based on the assumption that negative thoughts result in negative emotions and that well-adapted positive thoughts result in positive emotions, CBT tries to replace cognitive distortions (unhelpful thinking styles) with well-adjusted thinking patterns.

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