Anxiety is a normal response to a distressing event or perceived threat and most people experience some form of anxiety in their lifetime. Anxiety refers to the thoughts and bodily reactions a person has when they are presented with an event or situation that they feel they cannot manage or undertake successfully.1 It is often described as an uncomfortable feeling of vulnerability involving worry or fear and is commonly experienced in high pressure situations, for example, prior to a speech or presentation, while undertaking an exam, or following an accident.
Although the experience of anxiety will vary from person to person, a common feature for most individuals is a feeling of stress or worry. In addition to worry or negative thinking, symptoms of anxiety can include:
- Difficulty concentrating
- Avoidance behaviour
- Rapid heartbeat
- Trembling or shaking
- Feeling lightheaded or faint
- Numbness or tingling sensations
- Upset stomach or nausea
There is no single known cause of high anxiety. Rather, there are a number of risk factors or triggers that may contribute to the development of anxious thoughts, behaviours and physical symptoms.2 These include:
- Biological factors such as genetic predispositions, poor physical health
- Psychological factors such as low self-esteem, certain personality traits linked to anxious ways of interpreting events, unhelpful coping strategies (e.g., avoidance)
- Social-environmental factors such as marriage breakdowns, work or school deadlines, and financial hardship can also act as a trigger for anxiety.2
While anxiety is considered a natural reaction to a stressful situation, for some individuals anxious thoughts, feelings, or physical symptoms can become severe, and cause significant distress or interfere with their ability to cope with normal daily demands. If this occurs frequently or persists over a long period of time, the individual may at risk of developing an anxiety disorder.4
Anxiety disorders are the most common type of mental disorders diagnosed in Australia and can take a number of different forms.5 These include:
Generalised anxiety disorder
This disorder involves persistent and excessive worry, often about daily situations like work, family or health. This worry can be difficult to control and can interfere with an individual's day-to-day functioning, for example, reduced concentration, restlessness, irritability, fatigue, muscular tension, and difficulty sleeping.3, 6
People with a specific phobia experience extreme anxiety and fear if exposed to a particular feared object or situation. Common phobias include fear of flying, spiders and other animals, heights or small spaces.3, 6
Panic disorder occurs when a person has sudden surges of overwhelming fear and anxiety that come without warning. Common symptoms that may be experienced include the sudden onset of chest pain, heart palpitations, dizziness, and detachment from one's thoughts and behaviours. These panic attacks often only last a few minutes, but repeated episodes may continue to occur.3, 6
Agoraphobia involves intense anxiety following exposure to, or anticipation of, a variety of situations such as public transportation, open spaces, crowds, or being outside of the home alone.
Obsessive compulsive disorder (OCD)
Individuals with OCD have recurring, persistent, and distressing thoughts, images or impulses, known as obsessions, or feel compelled to carry out certain repetitive behaviours, rituals, or mental acts, known as compulsions. These thoughts and acts can take over a person's life and while people with OCD usually know that their obsessions and compulsions are an over-reaction, they are unable to stop them.3, 6
Social anxiety disorder
In social anxiety disorder the person has severe anxiety about being criticised or negatively evaluated by others. This leads to the person avoiding social events and being afraid of doing something that may lead to embarrassment or humiliation.3, 6
Post-traumatic stress disorder (PTSD)
PTSD refers to a set of symptoms that can occur in individuals after exposure to a frightening and traumatic event. People with PTSD re-experience the traumatic event through thoughts or images (e.g., nightmares) and tend to avoid places, people, or activities which remind them of the event. They can also feel irritable, angry, or over-alert and can experience concentration problems and difficulty getting to sleep or staying asleep.3, 6
Cognitive behaviour therapy (CBT) has been found to be the most effective treatment of anxiety disorders.7-9 CBT is a type of psychotherapy that helps an individual to modify unhelpful thoughts, feelings and behaviours.10 CBT combines some of the following strategies for identifying and challenging unhelpful thoughts:
An important step in the management of anxiety is the use of problem solving skills to help the individual cope with situations or thoughts that are making them stressed or anxious. Structured problem solving involves identifying the problem, developing and selecting a solution to the problem, implementing the solution, and evaluating its helpfulness.10
Exposure therapy is a CBT technique where the psychologist guides an individual through a series of real or imaginary scenarios to confront specific fears or distressing thoughts. Through a gradual process of exposure, the individual learns to deal with the frightening situation or object with decreased levels of anxiety.11
Feelings of anxiety sometimes stem from an individual's negative or maladaptive thoughts. Cognitive restructuring is a technique used by psychologists to help the individual challenge negative thoughts and develop a more rational and helpful style of thinking.2
Mindfulness techniques can be used to redirect an individual's attention from negative thinking. In using these techniques, psychologists help individuals focus on present moment experiences without worrying about the future or making any type of judgement about their current thoughts, physical sensations, or environment.11
Meditation and relaxation techniques
Many individuals who experience high levels of anxiety often report that they have trouble relaxing. Learning a relaxation technique, such as meditation or muscle relaxation, has been found to be an effective anxiety treatment.12 Relaxation techniques can be taught by psychologists and if practiced regularly, can help individuals' maintain a manageable level of anxiety in their daily lives.
In addition to the above psychological techniques, making simple changes to a person's lifestyle can help minimise the experience of anxiety.4 Developing a lifestyle to include regular exercise, having low or no intake of alcohol and caffeine, engaging in enjoyable activities, improving time-management skills and having adequate sleep can help to reduce an individual's anxiety levels.13
Through discussion with the client and the possible use of questionnaires and monitoring tools, the psychologist develops an understanding of the potential factors involved in the onset and maintenance of the individual's symptoms of anxiety. A treatment plan is then developed by the psychologist together with the individual. For anxiety disorders, this can involve CBT strategies to help bring about changes in thinking or behavioural responses.
The psychologist may also assist their client to address any lifestyle factors which may increase their capacity to better manage their difficulties, and reduce symptoms of anxiety. They may also suggest involving a supportive family member or friend to assist in the understanding of the individual's situation and to support treatment.
A medical review with a GP or another mental health specialist such as a psychiatrist may be suggested to determine whether another condition could account for the individual's symptoms. A GP or psychiatrist can offer advice and assistance around whether medication might be of benefit.
If anxiety is affecting a person’s work, school, home life, or relationships, psychological assistance should be considered. The APS Find a Psychologist service can be used to locate a psychologist in your local area: call 1800 333 497 or visit www.findapsychologist.org.au. A GP can also organise a referral to an APS psychologist under the Better Access to Mental Health Care items.
The Australian Psychological Society
Australia's largest professional association for psychologists
Provides information on anxiety, depression, and related disorders
Australia's National Youth Mental Health Foundation, providing assistance for individuals aged 12-25
A 24-hour counselling, suicide prevention and mental health support service
Telephone: 13 11 14
22 Jul 2013
- Richardson-Jones, J. W., Leonardo, E. D., Hen, R., & Ahmari, S. E. (2010). Animal models of anxiety disorders: Behavioral and genetic approaches In Helen Blair Simpson, Yuval Neria, Roberto Lewis-Fernandez & Franklin Schneier (Eds.), Anxiety Disorders: Theory, Research, and Clinical Perspectives (pp. 156-167). New York: Cambridge University Press.
- Hambrick, J. P., Comer, J. S., & Albano, A. M. (2010). Cognitive-behavioral treatment of anxiety disorders: Model and current issues In Helen Blair Simpson, Yuval Neria, Roberto Lewis-Fernandez & Franklin Schneier (Eds.), Anxiety Disorders: Theory, Research, and Clinical Perspectives (pp. 204-215). New York: Cambridge University Press.
- American Psychiatric Association. (2013). Diagnostic and Statistical Manual of Mental Disorders (5th ed.). Washington DC: Author.
- Andrews, G., Creamer, M., Crino, R., Hunt, C., Lampe, L., & Page, A. (2003). The treatment of anxiety disorders: Clinican guides and patient manuals (2nd ed.). New York, NY US: Cambridge University Press.
- ABS. (2008). National Survey of Mental Health and Wellbeing: Summary of Results, 2007 Retrieved 7 May, 2013, from www.abs.gov.au/AUSSTATS/abs@.nsf/DetailsPage/4326.02007?OpenDocument
- World Health Organization. (2008). ICD-10: International Statistical Classification of Diseases and Related Health Problems (10th Rev.). New York, NY: Author.
- Australian Psychological Society (APS). (2010). Evidence-based Psychological Interventions in the Treatment of Mental Disorders: A Literature Review (Third Edition). Melbourne: Author.
- Hunot, V., Churchill, R., Silva de Lima, M., & Teixeira, V. (2007). Psychological therapies for generalised anxiety disorder. Cochrane Database Syst Rev, 24(1).
- Royal, A., New Zealand College of Psychiatrists Clinical Practice Guidelines Team for Panic, D., & Agoraphobia. (2003). Australian and New Zealand clinical practice guidelines for the treatment of panic disorder and agoraphobia. Australian and New Zealand Journal of Psychiatry, 37(6), 641-656. doi: 10.1111/j.1440-1614.2003.01254.x
- Beck, J. S. (2011). Cognitive Behavior Therapy: Basics and Beyond (2nd ed.). New York, NY: Guilford Press.
- Antony, M. M., & Roemer, L. (2005). Behavior therapy. In Alan S. Gurman & Stanley B. Messer (Eds.), Essential Psychotherapies: Theory and Practice (2nd ed.). New York: Guilford Press.
- NICE. (2011). Generalised anxiety disorder and panic disorder (with or without agoraphobia) in adults. London: National Institute for Health and Clinical Excellence.
- Kaplan, A., & Laygo, R. (2003). Stress Managment. In W. O'Donohue, J. E. Fisher & S. C. Hayes (Eds.), Cognitive Behavior Therapy: Applying empirically supported techniques in your practice (pp. 411-417). New Jersey: John Wiley & Sons.
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