Defining anxiety

Feeling anxious is something many of us can relate to. This common experience means that feelings of anxiousness, anxiety and related problems such as panic attacks and stress, are often loosely defined and talked about. For many people however, anxiety is a mental health problem that can be concerning, severe and/or frequent. It can negatively impact how they think, feel and interact with the world. It can also impact overall health and well-being.  

In Australia, it is estimated that around 3.2 million people experience an anxiety related condition in any given year, making it the most common mental health problem. This makes understanding anxiety, and how to provide support to someone who is struggling with it, an important aspect of offering mental health first aid.

What is anxiety?

Anxiety disorders are diagnosable mental health problems that centre around experiences with anxious feelings. Some anxiety disorders you’ve probably heard of include: Generalised Anxiety Disorder; Panic Disorder; Post Traumatic Stress Disorder (PTSD); Social Anxiety Disorder; Agoraphobia; and Obsessive-Compulsive Disorder.

Anxiety, while common, is not simple. It can be distressing and debilitating. It can also be related to other traumas (past and present), life challenges, and health problems. Anxiety can vary greatly in severity, frequency, and long-term duration. 

Understanding this further
For most people, it is normal to feel anxiety sometimes, particularly in response to stressful situations. It alerts us to something being ‘not quite right’ and can prompt us to react. We might experience these sorts of feelings before doing something very important, when making major life decisions, or in unfamiliar or overwhelming situations. It is thought that common feelings of anxiety, panic and stress come from our innate ‘’flight-or-fight’’ response to external stimulus.

For those with anxiety disorder, these feelings and experiences are more challenging for one or more of the following reasons:

1. Severity: The feelings are of a moderate to extreme intensity, causing distress.
2. Frequency/longevity: The feelings are frequent – occurring at regular intervals, locations or times, and hard to keep at bay or the anxiety is experienced over a longer duration.
3. Interference: The feelings interfere with aspects of daily life such as self-care, regular activities, relationships, work, school or sense of self.

Signs and symptoms of anxiety
The way a person responds both internally and externally to their anxiety will vary greatly. In general, anxiety symptoms and signs can be grouped into four categories:

Thinking – this may include interrupted thought processes as well as an internal dialogue about the anxiety itself.

• Racing mind, too many thoughts and worries
• Going blank or frozen thoughts
• Repetitious or intrusive thoughts
• Inability to concentrate or being distracted
• Indecision or changing of mind
• Confusion or disorientation
• Trouble remembering or recalling memories
• Vivid or upsetting dreams

Feeling – this may include impact on moods and general feelings about self, situations, others and life. It can also impact a person’s beliefs and attitudes.

• Unrealistic fear or worry – often out of proportion with threats
• Distress and emotional discomfort
• Irritability or loss of composure
• Anger (at self, situation, or others)
• Nervousness or having ‘butterflies’ in the stomach
• Sadness over present or past events (this can also relate to depression)

Behaviour – this may include a person’s immediate, common or longer-term behaviours.

• Avoiding certain situations, places or people
• Experiencing distress when in public places or social situations
• Engaging in obsessive or compulsive behaviours
• Experiencing disturbed sleep
• Increased use of drugs or alcohol
• Increased dependence on other means to sooth or deflect
• Becoming more reclusive or shut off

Physical – while anxiety is a mental health problem it can have very real physical symptoms.

• Rapid heart rate, feeling of a pounding heart
• Chest tightness or pain
• Difficulties with breathing
• Feeling flushed, hot or cold, or sweating
• Dizziness or light headedness
• Tingling feeling or numbness
• Dry mouth, tight throat or trouble swallowing
• Nausea, upset stomach that can result in vomiting or diarrhoea
• Headaches or heavy head
• Muscular aches, stiffness or body tension
• Shaking, trembling or tremors
• Restless body or inability to get comfortable

Important Notes:

• Not everyone will experience all symptoms, some may have a few, some may have many, and with a great variation is severity and frequency.
• All symptoms can be disruptive, distressing and life changing.
• In the case of physical symptoms it can at times be difficult to discern if an underlying physical problem is also involved. In the case of heart or other extreme physical symptoms, it pays to rule out a medical emergency.
• It should also be noted that Panic Attacks are sometimes experienced by people with anxiety disorders. There can also be a separate mental health problem. To find out more about Panic Attacks read this related article.

Who experiences anxiety?

Anxiety disorders are common mental health problems, and you will likely know many people who experience them. Some people may be open about their experiences, and others might not. Additionally, some people may have been formally diagnosed while others may not.

Anxiety disorders impact around 1 in 4 Australians in any given year. The most recent ABS data also suggests that they are increasing, and with recent world events there are some suggestions by experts that anxiety is on the rise even further.

Anxiety can be experienced by almost anyone. It impacts women and men, though is experienced at significantly higher rate by women. It can affect children, young people, working age adults and older people. It can impact people from all walks-of-life, and we need to be prepared to respond to it as an important mental health topic that respects the experience of individuals.

Risk Factors (some of the things that may make anxiety more likely):

• Personality factors e.g. a tendency towards being more emotional or risk averse
• History with childhood anxiety
• Being a girl/woman/female
• Experience with a past traumatic event/experience
• Childhood emotional, physical or sexual abuse or neglect
• Alcohol or substance misuse
• A family history of anxiety disorders
• A challenging family history or home life
• Experiences with medical problems that can cause anxiety symptoms
• Use of certain prescription medications

What can be done about anxiety?

Anxiety disorders can be diagnosed by a medical professional and a good starting point is often a GP, counsellor, psychologist or mental health care nurse. Diagnosis will include undertaking certain assessments, and a person may be referred elsewhere if necessary. Anxiety Disorder treatment will vary depending on the type of disorder, the severity and the needs of the individual.

Treatments may include talk therapies, cognitive behavioural therapy or behaviour therapy with a qualified mental health care provider. Several medical treatments (prescription medicines) may also be used to treat symptoms. They must only be prescribed and monitored by a medical professional.

Adequate and appropriate mental health care and clinical treatment is important to managing and even recovering from anxiety disorders. There are however other supports that can play a role such as having a support network, avoiding negative stimulus such as alcohol and other drugs, and making positive life-style changes.

A person may also choose to undertake self-help to manage their anxiety and there are many options such as, self-help tools (books, websites, phone apps, digital resources), relaxation training and meditation, as well as engaging in positive hobbies and activities.  

5 ways we can help people with anxiety:

While Mental Health First Aid training teaches a more thorough intervention for people experiencing anxiety, based on the ALGEE® Action Plan, there are some things we can keep in mind to make our workplaces, schools and communities a more supportive place for people with anxiety.

Understand that anxiety is common but also unique to the individual. Respect that anxiety disorders vary and are a mental health problem that can cause significant distress and disruption. By being aware of the different types of anxiety disorders, and how commonly they are experienced, we can appreciate the challenges that others may be going through. This leads to empathy and offers of support.

Look for signs that someone may not be comping with their anxiety. Changes in behaviours, moods or the way a person is talking can give insights. If you notice signs it is time to make an approach to assess and assist the person.

Be supportive of people with anxiety. In Mental Health First Aid interventions this includes: listening and communicating non-judgementally and giving support and information that is targeted and helpful.

Connect with people who have anxiety, but also understand their need to connect with appropriate care. In Mental Health First aid this is encompassed by two actions on ‘encouraging’. Encouraging connection and pathways to care includes:

• Supporting people to get professional help
• Connecting people with care if they can’t do it themselves
• Motivating the person to keep trying to get the help they need.

• Suicide Call Back Service on 1300 659 467
• Beyond Blue on 1300 22 46 36
• Headspace on 1800 650 890