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Understanding and Managing Anxiety

Health Highlights; Patient Education; Caregiver Tips
​​It's normal to feel all kinds of emotions, but when is anxiety something that requires further intervention? By taking note of certain signs and symptoms, it can help you to better understand and deal with anxiety.​

What Is Anxiety?

Everyone experiences anxiety and fear from time to time. These are normal human emotions that help us in times of threat or danger and give us the push to deal with problems. However, an "anxiety disorder" is when your anxiety gets out of control and starts to affect your life, making it difficult to live life the way you want.

​Types of Anxiety Disorders 

Anxiety Disorders include:

  • Generalised Anxiety Disorder: This is when the anxiety is present all the time. You become overly worried about many things in your life and may expect the worst even where there's no apparent cause for concern. You find it hard to control these worries and it affects you physically and emotionally most of the day for at least the last 6 months.

  • Panic Disorder: This is when you experience sudden repeated feelings of intense anxiety and fear that reach a peak within minutes, even when there is no apparent cause. This is associated with physical reactions such as difficulty breathing and pounding heartbeat (panic attacks). You start worrying about these panic attacks happening again or you avoid situations where you worry these panic attacks might occur again.

  • Social Anxiety Disorder: You experience high levels of anxiety and fear in social settings due to feelings of embarrassment, self-consciousness and concern about being judged or viewed negatively by others. You have trouble talking to people or meeting new people, and may try to avoid all social situations.

  • Phobias: You experience high levels of anxiety and fear when you're exposed to a specific object or situation (e.g. needles, heights, insects) and have a strong desire to avoid it. Phobias can provoke panic attacks in some people.​

What Does Anxiety Feel Like?

Physical reactions: Sweaty palms, heart racing, shortness of breath, muscle tension, restlessness, flushed cheeks, light headedness, shaking or trembling, stomach churning, headaches, nausea and difficulty sleeping 

Feelings: Nervousness, irritability, dread, low moods, and panicky

Thoughts: Feelings of looming danger, underestimating your ability to cope, worrying about the availability of help, fearing the worst (for instance, worrying that you will be fired or you will faint), dissociation

Behaviours: Avoiding or leaving situations where anxiety may occur, trying to control things to prevent danger.

What Causes Anxiety Disorders?

Research suggests that anxiety disorders can be inherited through our genes and run in the family.

People with certain personality types, such as those who are easily worrisome or have low self-esteem, can be more prone to anxiety disorders.

Physical Health Problems
For some people, anxiety may be linked to an underlying health issue. Your doctor may order tests to check for conditions such as heart, lung and thyroid disease or diabetes, as some of these conditions can cause symptoms similar to anxiety disorders. Having a health condition or serious illness can also cause significant worry about issues such as your treatment and your future.

Traumatic Experiences
Children who endured abuse or neglect or witnessed traumatic events are at higher risk of developing an anxiety disorder at some point in life. Adults who experience a traumatic event may also develop anxiety disorders. These include death of a loved one or violent events.

Drugs or Alcohol
Misuse or withdrawal of street drugs, alcohol, and even caffeine can cause or worsen anxiety.

Other Mental Health Conditions
Anxiety disorders can also occur together with other mental health conditions such as depression.

Myths About Anxiety

Myth: Anxiety is just worry. You do not need to seek professional help. 
Fact: Clinical anxiety is not simply the act of worrying. It is accompanied by a range of symptoms including constant and overwhelming anxiety and fear. It is a diagnosable condition like other physical health conditions, and the symptoms require treatment to manage. It can often worsen without treatment and hinder daily functioning.

Myth: Anxiety can be reduced by avoiding situations in which it is triggered. 
Fact: Life can become very restricted if we try to avoid all stressful situations and triggers. Furthermore, avoidance behaviours will only increase our fear in the long run and maintain our symptoms of anxiety. We'll end up needing to avoid more and more situations in this cycle of panic. Instead, we can enjoy a fuller life if we learn to manage our anxiety.​

Myth: Medication is the only way to manage anxiety.
Fact: Medications, such as anti-depressants, may be used to treat anxiety, but there are also psychological therapies that help to manage anxiety. Often, a combination of medication and psychological therapy works the best.

Tips to Manage Anxiety

  • Learn a relaxation exercise, such as deep breathing, and use it regularly to keep yourself calm 
  • Keep engaged in activities that are meaningful and pleasurable so you do not get caught up in worries
  • Engage in self-care and take time off for yourself
  • Observe your thoughts and try to catch yourself when your worry is excessive. Try to think of different interpretations to the situation rather than jumping to the worst-case scenario
  • Be positive and try to reframe negative thoughts into motivation and affirmation
  • Try approaching situations that make you anxious. You may learn that your expected fears don’t come true, or that you are able to cope with the situations 
  • Set aside some “worry time”, say 10 minutes a day, to indulge in your worries. Do not engage with your worries at other times
  • Maintain a good support system and spend time with family and friends
  • Get regular exercise, adequate sleep and maintain a healthy and balanced diet
  • Avoid the use of caffeine, nicotine, alcohol and recreational drugs
  • Plan your time in advance to help you feel more in control of the tasks that need to be done

When to Seek Help

If you feel that you are having little improvement in your anxiety after trying different methods, speak to your doctor about what you are experiencing, or consult a mental health professional.

Anxiety is a treatable condition. Your mental health professional will ask you a series of questions regarding your past and current life events to understand you and your difficulties better. You may also be asked to fill out a series of questions regarding your symptoms, behaviours and lifestyle.

After this initial assessment, you may be advised to seek psychological therapy (talk therapy) to learn skills to manage your anxiety better. If necessary, medication may also be prescribed. 

Several types of medications are used to help relieve anxiety symptoms.

  • Medications such as selective serotonin reuptake inhibitors (SSRIs) are the mainstay of treatment and help reduce anxiety symptoms through balancing the serotonin chemicals in the brain. These medications should be taken daily.
  • In limited circumstances, your doctor may prescribe other types of medications such as sedatives, also called benzodiazepines, or beta blockers. These medications are for short-term relief of anxiety symptoms and are not intended to be used long term.

How is an assessment of anxiety done? 

Just like other medical appointments, you will be asked a series of questions regarding your past and current life events to understand you and your difficulties better. You may also be asked to fill out a series of questions regarding your mood, behaviours and lifestyle. 

Some of these questions can feel very personal to you and it is common that you may feel slightly nervous and uncomfortable. However, your clinician will help to make the process easier and you can take your time to share. The healthcare professionals will help you come to terms with your emotions and the process of managing your illness.

Contributed by Department of Medical Psychiatry and Psychology.
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