Anxiety

Life is a rollercoaster and it's totally normal to experience anxiety throughout it. However, the 'anxiety' we hear and see splattered all over social media is of a different nature to that experienced when actually stepping onto a rollercoaster. Often when we refer to anxiety as a problem we don't mean the mere experience of it, but the degree to which it can effect people. This is because some people are less able to deal with or have more intense feelings of anxiety than others, to the extent where it may begin to have an impact on their day-to-day life.

Anxiety... it's "all in your head"... right? Right... the feeling of anxiety does arise in the head, specifically in a region of the brain known as the amygdala, which regulates our emotions, but is particularly involved in detecting fear. This has been proved by many functional neuroimaging studies, showing increased activity in this region during anxiety episodes. When the amygdala senses anxiety, chemicals (known as neurotransmitters, such as serotonin or glutamate) are released. The action of these chemicals is comparable to the amygdala sending a text to the rest of the body, telling it to prepare for fight or flight. As neurotransmitters carry the impulse to the sympathetic nervous system, both heart and breathing rates increase, muscles tense, and blood flow is diverted from the abdominal organs to the brain. In the short term, anxiety prepares us to confront a crisis by putting the body on alert. But the physical effects of this can be counterproductive, causing light-headedness, nausea, diarrhoea  and frequent urination; which are not really helpful in fight or flight scenarios anyway, let alone if you're just rearing yourself up to go out for the day. 

The Amygdala

The NHS definition of  Generalised Anxiety Disorder (GAD) is that it is a long-term condition that causes an individual to feel anxious about a variety of things rather than one in particular. It is a common condition, affecting ~5% of the UK's population, with a slightly higher incidence in females than males. It is also more common in those between the ages of 35-59. Social anxiety disorders are characterised by an overwhelming self-consciousness in ordinary social encounters, heightened by a sense of being watched and judged by others, as well as a fear of embarrassment. Social anxiety typically arises during the teenage years - by age 11 in ~50% and by age 20 in ~80% of individuals (Stein et al., 2008). What is more concerning is that it often acts as a risk factor for the development of subsequent depressive illness or substance abuse. 

Many of these conditions overlap (Stein et al., 2008)

Anxiety is  reaction to stress - thus, there are many psychological symptoms of GAD including:

• Restlessness
• A sense of dread
• Feeling constantly "on edge"
• Difficulty concentrating
• Irritability

Specific to social anxiety:

• Dread everyday activities, such as meeting strangers, starting conversations, speaking on the phone, working or shopping  
• Avoid or worry a lot about social activities, such as group conversations, eating with company, and parties 
• Always worry about doing something you think is embarrassing, such as blushing, sweating or appearing incompetent 
• Find it difficult to do things when others are watching – you may feel like you're being watched and judged all the time 
• Fear criticism, avoid eye contact or have low self-esteem

In addition to psychological symptoms, many people with anxiety also experience physical symptoms, such as:

• Dizziness
• Tiredness
• Heart palpitations
• Muscle aches & tension
• Trembling or shaking
• Dry mouth
• Excessive sweating
• Shortness of breath
• Stomach ache/feeling sick
• Pins and needles
• Headache
• Insomnia
• Panic attacks (where you have an overwhelming sense of fear and anxiety, usually only for a few minutes)

If it is the case that you are experiencing some of these symptoms and that they are affecting your quality of life or causing you distress, it is recommended that you see a GP.

When anxiety persists, it is possible for it to take a toll on both our mental and physical health. In 2017 Kang et al. found that anxiety alone was associated with the incidence of heart disease, depression alone with the incidence of asthma, and comorbid anxiety and depression (simply meaning you experience both) with incidence of eyesight problem, persistent cough, asthma, hypertension, heart disease, and gastrointestinal problems.

Getting Better

With the expanding awareness of anxiety there are now many websites, podcasts, apps etc. that have been created to help people deal with their anxiety without necessarily requiring a visit to the GP. 
😊NHS recommended website: Anxiety UK
😊NHS recommended podcast by an anxiety specialist
😊NHS recommended apps

Its important to try to understand why you may be experiencing anxiety and what your body goes through when you do - without understanding your anxiety you won't be able to begin to tackle it. Anxiety is often associated with irrational beliefs and if you break these down, you will often find that there are no facts to support these thoughts. This will make it easier for you to ultimately shut these damaging thoughts down.

One way to make this method more achievable would be to write a diary or a blog to document how you feel when you experience anxiety. It may also be a good idea to record what you did in order to help yourself get through it.

It is also important not to focus on yourself in social situations - focus on other people instead... explains why "people watching" makes us all so content, right??

EXERCISE MAKES EVERYTHING BETTER. It improves your physical AND mental health. It doesn't even need to be intense exercise - perhaps just go for a walk.

Most importantly, find things that enable you to relax: Read a book, listen to your favourite music, watch your favourite show on Netflix, play your guitar (or whatever), paint or dance it out like Meredith Grey. Whatever makes you happy.

Treatment

Many people are on the fence about the most effective method to treat anxiety. Drug therapy to tackle anxiety have been shown to be less effective than psychotherapies in the long term and often include many unpleasant side effects. Some of the commonly used drugs prescribed for anxiety are:

• Anti-anxiety drugs were developed specifically to relieve anxiety. They act rapidly and have few side effects (except occasional drowsiness). However, it is possible to develop tolerance to these drugs (and therefore require increasing doses) and so they are not recommended for long-term use. Examples include: Benzodiazepines — clonazepam (Klonopin) and alprazolam (Xanax).

• Antidepressants: Antidepressants, especially selective serotonin reuptake inhibitors (SSRIs) such as sertraline (Zoloft), have been replacing benzodiazepines in the long-term treatment of panic and generalised anxiety disorders. These drugs act by preventing serotonin from being taken back up into neurons, which means it remains active and able to elicit effects including wellbeing and happiness - essentially this is like people queuing up to get food: once they have their food they want to go back home, but if they stay in the queue they will get more food, aka they will feel happier. Antidepressants have the advantage of relieving depression as well as anxiety, and they are believed to create less risk of dependence and abuse.

• Beta blockers: These drugs can help relieve the symptoms of acute anxiety by slowing the heart rate and reducing blood pressure. They are often used, for example, to treat stage fright. However, these drugs only remove the physical symptoms associated with increased heart rate, and do not address the many other symptoms and underlying issues at the root of anxiety.

Alternative methods of treating anxiety disorders are the psychological therapies. These therapies tackle the root cause of the individuals anxiety and so are typically more effective methods of treatment. These includes:

• Cognitive-behavioral therapy: The cognitive component helps people identify and avoid thoughts that generate anxiety, and the behavioral part helps them learn how to react differently to anxiety-provoking situations. The specifics of the treatment depend on the type of anxiety. For example, patients with generalized anxiety disorder or panic disorder may be asked to examine their lives for habits and patterns that foster a sense of dread. They may also be taught relaxation techniques to diminish anxiety.

• Psychodynamic psychotherapy: Anxiety is often triggered by a deep-seated emotional conflict or a traumatic experience that can sometimes be explored and resolved through psychotherapy. In the first randomized controlled clinical trial comparing relaxation therapy to psychodynamic psychotherapy (focused talk therapy), clinician-researchers at Columbia University in New York found that panic-disorder patients treated with psychodynamic therapy had significantly fewer symptoms and functioned better socially than those who underwent relaxation therapy. Nearly three-quarters of the psychotherapy group responded to treatment compared with only 39% of the relaxation-therapy group.

The important thing to remember is that most symptoms of anxiety are not visible to others... this means that people will not usually notice if you are experiencing anxiety, but also that you will not notice those around you experiencing it. Anxiety is more common than you realise. So remember to check in with your friends - for there sake, as well as for yours.