Anxiety Disorders

Generalised Anxiety Disorder (GAD)
Generalised anxiety disorder (GAD) is a condition that causes excessive and persistent worry and nervousness about everyday life events. Individuals with GAD will generally feel anxious most of the time and report worrying about everything.  Their worry is experienced as distressing and comes in two forms:

• Type 1 worries are concerned with daily events such as relationships, finance, news etc.
• Type 2 worries focus on the consequences of the worry itself (eg. worry about worrying).

People with GAD may find it hard to relax, sleep, concentrate, or cope with stress. They may also experience physical symptoms such as headaches, nausea, sweating, or heart palpitations.

GAD can be treated with a combination of psychological therapies and medication. Psychological therapies aim to help people change their thinking and behaviour patterns that contribute to their anxiety. The most common types of psychological therapies for GAD are cognitive behavioural therapy (CBT) and applied relaxation. CBT teaches people how to identify and challenge negative thoughts and beliefs that cause anxiety, and how to replace them with more realistic and positive ones. Applied relaxation teaches people how to relax their muscles and calm their mind in response to anxiety triggers.

Medication can help reduce the severity of anxiety symptoms and make psychological therapies more effective. The most common types of medication for GAD are antidepressants and anti-anxiety drugs. Antidepressants can help rebalance the chemicals in the brain that affect mood and emotions. Anti-anxiety medication can help reduce the physical sensations of anxiety, such as trembling or racing heart. However, medication can also have side effects and may not be suitable for everyone.

Health Anxiety
Health anxiety is a condition that causes a person to worry excessively about their health, even when they have no or mild symptoms. Health anxiety can interfere with a person’s daily life and make them feel distressed and unhappy.

Someone suffering health anxiety may be convinced they are seriously ill, even though there is no evidence to suggest this.  They may seek constant reassurance from others, such as a GP, medical journals or the internet.  Equally, a person may avoid anything that reminds them of serious diseases/health issues, including avoiding visiting a GP due to a fear of what the results of an examination might confirm.

Health anxiety can be treated with psychotherapy, medication, or both. Psychotherapy is a type of talking therapy that helps a person understand and change their thoughts and behaviours related to their health worries. One of the most effective forms of psychotherapy for health anxiety is cognitive behavioural therapy (CBT). CBT teaches skills to challenge negative thoughts, cope with anxiety, and reduce avoidance and checking behaviours.

Medication can also help reduce anxiety symptoms and improve your mood. Some common medications for health anxiety are selective serotonin re-uptake inhibitors (SSRIs), which are a type of antidepressant. SSRIs work by increasing the level of serotonin in your brain that regulates your mood and emotions. Sertraline is one of the most commonly prescribed SSRIs for health anxiety, but there are alternatives and your GP will be able to advise you on these.

Panic Disorder with or without Agoraphobia
Panic disorder is a type of anxiety disorder that involves recurrent and unexpected panic attacks. A panic attack is a sudden episode of intense fear and distress that can cause physical and psychological symptoms, such as chest pain, change in breathing, dizziness, sweating, trembling, and a feeling of impending doom. Although panic attacks do not generally last for very long, they can be extremely distressing, appear to come on suddenly without warning and the result of one can stay with you for quite a long time afterwards.

Panic disorder can interfere with daily functioning and quality of life, and may lead to other mental health problems, such as depression or phobias. People with the disorder may live in constant fear of having another panic attack, and may avoid situations or places that they think might trigger one. For example, a person with panic disorder may stop going to work, school, or social events, or may develop agoraphobia, (a fear of being in places where escape or help might be difficult). Furthermore, due to the physical changes that occur when a panic attack is triggered, many people appraise these as a belief that they may be having a heart attack, losing control, going crazy or possibly suffocating. However, whilst distressing, a panic attack is not life threatening. 

Panic disorder can be treated with psychotherapy, medication, or a combination of both. Psychotherapy, such as cognitive-behavioural therapy (CBT), can help people learn to cope with their panic symptoms and challenge their negative thoughts and beliefs. For example, CBT can help people identify and modify the triggers and patterns of their panic attacks, and teach them how to face their fears gradually and safely. 

Medication, such as antidepressants or anti-anxiety drugs, can help reduce the frequency and severity of panic attacks, improve mood and functioning. However, medication may have side effects or withdrawal symptoms, and should be taken under medical supervision. 

Some people may also benefit from self-help strategies, such as relaxation techniques, breathing exercises, mindfulness, or exposure therapy. For example, relaxation techniques can help calm the body and mind during a panic attack; breathing exercises can help regulate breathing and prevent hyperventilation; mindfulness can help focus on the present moment and not on their worries; and exposure therapy can help confront fears within a controlled environment.

Social Anxiety/social phobia
Social anxiety disorder (SAD), previously known as social phobia, is a type of anxiety disorder that makes people feel extremely nervous and uncomfortable in social situations. It is a fear of social situations in which there is a ‘perceived social danger’ such as becoming embarrassed, making a fool of yourself or not knowing what to say etc. People with social anxiety are afraid of being judged, criticised, rejected or embarrassed by others.

People struggling with social anxiety turn their focus inwards and then naturally lose the focus of what is going on around them, causing more anxiety. They become pre-occupied with their own negative thoughts concerning others evaluation of them and focus on their heightened physical responses. Responses may include anxiety, sweating, trembling, blushing, nausea or heart palpitations. These responses together with their fear of judgement, lead to avoidance or dreading social activities such as meeting new people, speaking in public, eating or drinking in front of others, or going to parties. 

Social anxiety can have a negative impact on a person’s quality of life, self-esteem, relationships and work or school performance. It can also increase the risk of developing other mental health problems, such as depression. The exact causes of social anxiety are not fully understood, but they may involve genetic, environmental and psychological factors. Some possible causes are:

• Having a family history of anxiety disorders
• Experiencing trauma, abuse or bullying in childhood or adolescence
• Having an overprotective or critical parenting style
• Having a shy or introverted personality
• Living in a culture that values conformity or perfectionism

Social anxiety can be treated with psychotherapy, medication or both. Cognitive behavioural therapy (CBT) is one of the most effective forms of psychotherapy for social anxiety. It teaches people how to identify and challenge their irrational fears and beliefs, and cope with their anxiety using relaxation techniques and exposure exercises. Exposure exercises involve gradually facing the feared situations in a safe and controlled way, until the anxiety decreases.

Medication can help reduce the physical and emotional symptoms of anxiety and make it easier to participate in psychotherapy. Medications should be prescribed by a doctor who can monitor their effects. They should not be stopped abruptly without consulting the doctor, as this can cause withdrawal symptoms or relapse. Medications should also be used in combination with psychotherapy for the best results.

Social anxiety is a common and treatable condition that does not have to limit a person’s life. With proper treatment and support, you can overcome your fears and enjoy social interactions with confidence and ease.

Obsessive Compulsive Disorder (OCD)
Obsessive-compulsive disorder or OCD, is a chronic mental health condition that affects millions of people around the world and often has a major negative impact on a person’s life. The exact cause of OCD is unknown but it may be related to genetic, environmental, or brain factors.

A primary feature of OCD is where a person experiences frequent, unwanted and intrusive thoughts, images, or impulses (called obsessions) that causes them anxiety or distress. An example of this may be a fear of germs/contamination or harm. They also may feel compelled to perform repetitive behaviours or mental acts (called compulsions) such as excessive cleaning or checking, in order to reduce their anxiety or prevent ‘something bad’ from happening. However, these compulsions often provide only temporary relief. Obsessions and compulsions can be extremely distressing for an individual and their family, as well as impacting heavily on their day to day functioning.

There are various types of OCD:
• Cleaning
• Ordering
• Hoarding
• Counting
• Checking
• Pure ‘O’ (unwanted intrusive thoughts eg. violence, sexual)

OCD can be treated with psychotherapy, medication, or a combination of both. The most common type of psychotherapy for OCD is cognitive behavioural therapy (CBT) with exposure and response prevention (ERP). This involves gradually confronting the feared situations or thoughts that trigger the obsessions, while resisting the urge to perform the compulsions. This helps a person learn to tolerate any uncertainty and distress and break the cycle of OCD. 

The most commonly prescribed medications for OCD are selective serotonin re-uptake inhibitors (SSRIs), which are a type of antidepressant that can help balance the brain chemicals involved in OCD. SSRIs can take several weeks to work and may cause some side effects, such as nausea, insomnia, or agitation. It is important to follow your doctor’s instructions and not stop taking the medication without consulting them first.

For more information on OCD, please see ocduk.org.