Don't let anxiety get out of control


“I am an old man and have known a great many troubles, but most of them never happened”– Mark Twain

FOR SOME, it’s a heavy feeling in the pit of the stomach. For others, it can be muscle tension or headaches, difficulty getting to sleep, irritability, a rapid heart rate, trouble concentrating, sweating, trembling or diarrhoea.

Anxiety affects people differently and it is something we all experience at some time in our lives. It is an uncomfortable feeling of fear or imminent disaster and is a normal response to danger. In the appropriate situation, such as a threat to life, a high level of anxiety would be considered normal and even helpful. In performance situations such as interviews and exams, it can help us perform to the best of our ability.

However, problems arise when a person’s anxiety response is out of proportion to the actual danger they face, or when it is present in situations where there is no actual threat, explains Debbie Van Tonder, clinical nurse specialist in anxiety disorders at St Patrick’s University Hospital, Dublin.

“It’s when anxiety begins to interfere with normal day-to-day activities that people need to seek help as they may be suffering from an anxiety disorder. We have had a waiting list for our anxiety disorder programme at St Patrick’s since February, which is unprecedented,” says Van Tonder.

“Anxiety is increasing in Ireland and we are seeing far more anxiety disorders than we did three or four years ago. It’s probably linked to the recession, but I think people are also more aware of their emotional and mental health.”

Anxiety disorders are the most common mental health problem, along with depression, affecting Ireland and Europe. They account for a similar level of stress and disability as cancer or heart disease, according to research.

There are no accurate figures on the prevalence of anxiety disorders in Ireland, but it is estimated that one in nine individuals will suffer a primary anxiety disorder in their lifetime.

Only a fraction of these people will receive appropriate treatment which is a great pity, says Van Tonder, as it has been demonstrated consistently that with the right therapy, the majority of sufferers can achieve a lasting improvement.

Over the past few decades, explains Van Tonder, there has been a dramatic improvement in our understanding of anxiety and how it can be treated. You don’t have to go through life being a worrier, stressing about situations that are unlikely to happen or even if they do, are not worth worrying yourself sick over.

When worrying gets out of control, a person may be diagnosed with generalised anxiety disorder. This is a condition where sufferers spend long periods agonising over what they anticipate or fear might go wrong and is one of the most common anxiety disorders. Symptoms include distress, sleep disturbance, difficulty concentrating and exhaustion.

However, there is a lot people can do to help themselves to reduce their anxiety levels before they require professional intervention, according to Van Tonder. Those who feel their worrying is out of control should contact their GP and, if appropriate, can be referred on for specialist treatment.

“Probably the worst thing you can do is to try to avoid your anxiety and escape from it by going to bed with a valium, for instance,” she says.

“The rule of thumb is that you should do exactly the opposite of what your anxiety wants you to do. For example if your anxiety does not want you to get into a lift, you should get into a lift.

“It’s about facing the fear because it’s an irrational fear that is based on the person’s appraisal of danger rather than actual danger.”

Van Tonder says normal anxiety occurs where there is a perception of threat, for example if the car in front of you stops suddenly and you have to slam on the brakes.

It’s normal for your heart to start pounding or your hands to sweat in such a situation. However, when anxiety starts interfering with your daily functioning, you may have a problem.

For people who want to reduce their own anxiety, she recommends the book Overcoming Anxietyby Helen Kennerley, a self-help guide using Cognitive Behavioural Therapy (CBT) techniques. The book is one of a series used by the therapists at St Patrick’s.

For people who need professional help to deal with out-of-control anxiety, Van Tonder points out that CBT has been shown to be the best treatment for anxiety disorders. The talking therapy helps the sufferer to break the cycle of anxiety and gradually master their fears, she explains.

CBT is based on the idea that our thoughts strongly influence our feelings and behaviour, therefore unhelpful, negative and unrealistic thoughts can be a major source of distress.

St Patrick’s University Hospital operates a free support line for those worried about their own, a family member or friend’s mental health. The service, which is staffed by experienced mental health nurses, is available Monday to Friday; 01-2493333

Tell Tale Signs: Common Types of Anxiety Disorder

Panic Disorderis characterised by sudden episodes of acute severe anxiety/panic associated with a fear of death or collapse. The key feature of the disorder is the sudden onset, with no identifiable trigger. It can be accompanied with a persistent concern about future attacks and the consequences of the attack.

Prolonged Panic Disordercan lead to agoraphobia, a condition defined by anxiety/fear about being in situations from which escape might be difficult or embarrassing in the event of suddenly developing a panic attack or panic-like symptoms, or where help is not readily available.

Social Anxietyis excessive anxiety and self-consciousness in social situations with a central fear of being judged negatively or harshly or appearing foolish. It leads to avoidance of social or performance situations, such as public speaking, as well as subtle forms of hiding away in social gatherings.

Generalised Anxiety Disorderis characterised by uncontrolled worrying. Sufferers spend long periods agonising over what they anticipate might go wrong in the future. It is one of the most common anxiety disorders, affecting 2-8 per cent of the population. Symptoms include distress, sleep disturbance, difficulty concentrating and exhaustion.

Obsessive Compulsive Disorderis the name given to a condition in which people experience repetitive and upsetting thoughts and/or behaviours. Obsessions come in the form of intrusive, unwanted involuntary thoughts, images or impulses. Compulsions are repetitive, purposeful behaviours performed in a response to an obsession or according to certain rules.

Post-Traumatic Stress Disorderis a psychological reaction that develops following exposure to an overwhelming, frightening or traumatic event such as a road traffic accident or an assault. Symptoms include distressing memories and flashbacks of the event, avoidance of any reminders of the event, withdrawal from others, increased vigilance and sleep disturbance.