Anxiety, Stress & Panic Disorders
Agoraphobia is an anxiety disorder that presents itself as a fear of situations where escape can be difficult, or in which help would be unavailable were something bad to happen. The condition is often misunderstood as a fear of open spaces. It is more complex than that, and may involve a fear of crowds, bridges or of being outside alone.
Agoraphobia often develops after having one or more panic attacks and can make it difficult for someone to leave the house. Places in which agoraphobia is induced can include those that can make a person feel helpless, embarrassed or trapped, such as bridges, remote areas and public transport.
Since 2013, DSM-5 states that someone no longer needs to acknowledge the excessiveness of their anxiety, in order to be diagnosed.
Agoraphobia can present itself as a comination of feelings, fears and physical symptoms. A person with agoraphobia will commonly fear:
- spending time alone
- being in open, crowded or small spaces
- embarrassment or of showing it
- losing control in a public space
- being stared at
- losing sanity
- death, or a life-threatening panic attack
The main fear is that of being in a situations where help or escape will be be impossible should danger arise.
Apart from fear, a person with agoraphobia may experience the following:
- detachment from others
- loss of control
- a feeling that the body or environment is not real
- racing heart
- shortness of breath
- chest pain or discomfort
- upset stomach, nausea and diarrhoea
- flushing and chills
People who experience panic attacks may change their behaviour and function in the home, school or workplace. They may avoid triggering situations. They may become sad or depressed and may consider suicide. Some may turn to substance abuse.
Agoraphobia is usually treated with a combination of medication and psychotherapy.
Psychiatric professionals may prescribe one or the following types of medication:
- Selective Serotonin Reuptake Inhibitors (SSRIs), a type of antidepressant. Other types of antidepressant may have greater adverse effects. Caution is advised, as starting and ending a course of antidepressant can sometimes lead to side effects that are similar to a panic attack.
- Anti-anxiety medication (benzodiazepines) are sedatives that relieve anxiety symptoms in the short term. They are extreme addictive and have bad withdrawal symptoms.
Cognitive Behavioural Therapy (CBT) focuses on changing the thoughts that cause agoraphobia. Therapy helps people change their relationship to their symptoms, and better ontrol and cope with them.
Self-help Tips – For Managing Symptoms:
- Sticking to the recommended treatment
- Learning relaxation techniques
- Trying to face feared situations so that they become less frightening
- Avoiding alcohol, caffeine and recreation drugs
- Regular exercise
- Enough satisfying sleep
- A balanced diet
Social Anxiety Disorder
Social anxiety disorder, also called social phobia, is an anxiety disorder in which an individual has excessive and unreasonable fear of social situations. Anxiety and self-consciousness are a result of a fear of constantly being judged, watched or criticised by others.
The individual is afraid of making mistakes, looking bad and being humiliated in front of others. A lack of social skills or experience may worsen the fear. A panic attack can result from this anxiety. A result of the fear is the avoidance of certain social situations, or the endurance of them in great distress. People with social anxiety disorder also often suffer from anticipatory anxiety. In many cases, people are aware that their fear is unreasonable, but still struggle to overcome it.
People with social phobia suffer from distorted thinking that include false beliefs about social situations and the negative opinions of others. Without treatment, social phobia can negatively interfere with the person’s normal daily routine, including school, work and relationships.
Situations that commonly provoke anxiety include:
- Speaking in public
- Being the centre of attention
- Interacting with people
- Using public toilets
- Phone calls
- Writing or working in front of others
- Eating or drinking in front of others
Social anxiety disorder may be accompanied by other mental illnesses such as panic disorder and depression.
- Intense anxiety in social situations
- Avoidance of social situations
- Physical symptoms of anxiety, including sweating, a pounding heart, shaking, blushing, muscle tension, confusion and diarrhoea
Children with social anxiety disorder may express their anxiety by crying, throwing a tantrum or clinging to a parent.
When a physical exam reveals that social anxiety disorder symptoms are not caused by physical illness, the doctor may send you to a psychiatrist or psychologist, who will use interview assessment tools specially designed to evaluate someone for anxiety disorder. Diagnosis is based on his or her’s reports of the intensity and duration of symptoms. The doctor then determines whether or not the symptoms and degree of dysfunction indicate social anxiety disorder.
Cognitive Behavioural Therapy (CBT) – the most effective treatment currently available, the person’s thoughts are guided in a more rational direction and help them stop avoiding the situations that trigger their anxiety. The person is taught to react more healthily to these situations.
Medication – there are several different types of drugs used to treat social anxiety disorder, including antidepressants, sedatives beta-blockers (often used to treat heart conditions, may minimise certain physical symptoms such as shaking and rapid heartbeat).
Counselling to improve self-esteem and social skills and relaxation techniques may aslo help with social anxiety disorder. Unfortunately, social anxiety disorder cannot be prevented, but the outlook is generally positive with treatment.
Generalised Anxiety Disorder
Excessive and persistent worry about a number of things, characterises Generalised Anxiety Disorder (GAD). Individuals with GAD find it difficult to control this worry, and may anticipate disaster while being overly concerned with family, health, money, family or other areas. Even when there is no apparent reason to be concerned, individuals with GAD expect the worst of futùre and worry more than what seems worried about actual events.
In order to be diagnosed, the adult person must find it difficult to control the worry on more days than not for at least 6 months, and has 3 or more of the following symptoms. Only one is required for diagnosis in children.
Symptoms of GAD include the following:
- muscle tension
- feeling “keyed up” or on edge
- being easily fatigued
- sleep disturbance (bad quality of sleep, restless sleep, difficulty falling or staying asleep)
Even when people with GAD are aware that they worry more than what is warranted, they find it difficult to stop or control the worry cycle. Sometimes just the idea of getting through the day will induce anxiety. People with GAD can function socially, be gainfully employed and have full, meaningful lives when the anxiety is mild to moderate with treatment. Many people with GAD avoid situations because their worry will prevent them from taking full advantage of them (promotions, social situations, travel etc).
A number of treatment types can help with GAD. Treatment types include:
- Cognitive Behavioural Treatment (CBT) has been more researched. It specifically targets thoughts, physical symptoms and behaviours that characterise GAD. All therapies help people change their relationship to their symptoms. CBT helps people with GAD with understanding the nature of anxiety, to be less afraid of its presence, and to help people make choices independent of anxiety. The adult CBT treatments for GAD have been modified for children and teens.
- A number of medication choices are available for GAD, that are usually the Selective Serotonin Reuptake Inhibiors (SSRIs) by themselves or in combination with the CBT.
- Relaxation techniques, yoga, meditation, exercise and other alternative techniques
GAD rarely occurs alone, and is often accompanied by depression, another anxiety disorder and substance abuse. Co-occuring conditions must also be treated appropriately.
Acute Stress Disorder
Acute Stress Disorder is most often diagnosed when the traumatic event to which the person was exposed has the following features:
- The person witnessed or was confronted with (the learning of can be included) an event(s) that involved actual or the threat of death or serious injury, or a threat to the physical integrity of others.
- The person’s response is likely to involve intense fear, horror or the feeling of helplessness.
During or after the traumatic event, the individual exhibits 3 or more of the following dissociative symptoms:
- Reduction in the awareness of one’s surroundings
- A sense of numbness/detachment, and an absence of emotional responsiveness (all subjective)
- Dissociative amnesia (eg the inability to recall an important aspect of the distressing event)
For acute stress disorder to be diagnosed, the problems listed above must cause clinical impairment/stress in social, occupational or other areas or functioning. Alternatively, it impairs the individual’s ability to pursue some necessary task involved in seeking and obtaining assistance with dealing with the traumatic event.
The disturbance must last 3 days at minimum, and a maximum of 4 weeks. It must also occur within 4 weeks of the traumatic event. Symptoms also cannot be a result of substance use or abuse caused by or an exacerbation of a general or pre-existing medical condition, and cannot be better explained by a brief psychotic disorder.
One or more of the following methods to treat Acute Stress Disorder may be used:
- Hospitalisation (should you be at risk of harming yourself or others)
- Psychiatric education about your disorder
- A psychiatric evaluation, to see what your specific needs are
- Medication to relieve symptoms, such as anti-anxiety medication, selective serotonin reuptake inhibitors (SSRIs) and antidepressants
- Exposure-based therapies
- Cognitive behavioural therapy (may increase recovery speed and prevent escalation to Post Traumatic Stress Disorder
An intense wave of fear characterised by its unexpectedness and debilitating and immobilising intensity. There may be no clear reason for an attack, and can even occur while you’re relaxed or asleep.
Panic attacks may be a one-time occurrence, but many people experience repeat episodes. Specific situations often trigger recurrent attacks, such as driving a car or speaking in public, especially if that situation has previously triggered an attack. The situation is usually one in which you feel endangered and unable to escape.
Panic attacks may occur by themselves, or as part of another disorder, such as panic disorder, Social Anxiety Disorder or Depression. Panic attacks are treatable, regardless of cause.
Panic attack symptomps develop abruptly and usually reach their peak within ten minutes, usually end within 20 to 30 minutes, and rarely last more than an hour.
- Chest pain or discomfort
- Trembling or shaking
- Shortness of breath or hyperventilation
- Choking feeling
- Feeling unreal or detached from your surroundings
- Nausea or upset stomach
- Feeling dizzy, faint or light-headed
- Numbness or tingling sensations
- Hot or cold flashes
- Fear of dying, losing control or going crazy
Panic attacks can happen anywhere, at any time. You may be experiencing a panic disorder if you:
- worry a lot about having another attack
- experience frequent, unexpected attacks that aren’t tied to a specific situations, are behaving differently because of the panic attacks, such as avoiding places where you’ve previously panicked.
Panic attacks take an emotional toll when you have panic disorder. The memory of the intense fear and terror felt during an attack can have negative effects on your self-confidence and cause serious disruption to your everyday life. Eventually, this leads to the following panic disorder symptoms:
- Anticipatory anxiety – feeling anxious and tense between anxiety attacks. This fear of experiencing more panic attacks can be extremely dilapidating.
- Phobia avoidance – believing that certain situations caused previous panic attacks, will make you actively avoid them. You may avoid places where escape is difficult and help would be unavailable should you have a panic attack. Taken to its extreme, phobia avoidance becomes agoraphobia.
The exact causes of panic attacks is unclear, but the tendency to have them seems to run in families. There also appears to be a correlation between panic attacks and major life transitions such as getting married, graduating from university and entering the workplace and having a baby; as well as severe stress such as having a baby, divorce, the death of a loved one and job loss.
Panic attacks can be caused by medical conditions and other physical causes. If you’re suffering from symptoms, it’s important to see a doctor so as to rule the following possibilities out:
- Mitral valve prolapse (minor cardiac problem that occurs when the heart’s valves don’t close properly)
- hypoglycemia (low blood sugar)
- Stimulant use (caffeine, cocaine, amphetamines)
- Medication withdrawal
Treatment for Panic Attacks and Panic Disorder:
Cognitive Behavioural Therapy (CBT) – generally believed to be the best type of treatment for panic disorder, panic attacks and agoraphobia. The focus is on the thinking patterns and behaviours that are sustaining or triggering panic attacks. It helps you look at your fears in a more realistic light.
Exposure Therapy – in exposure therapy for panic disorder, the opportunity to learn healthier ways of coping is created by exposing you to the physical sensations of panic in a safe and controlled environment. You may be asked to shake your head, hold your breath or hyperventilate so that you becomes less afraid of the internal bodily sensations and feel a greater sense of control over your panic. If you have agoraphobia, you will be exposed to the situations you fear and therefore, avoid. Through this method, you learn that the situation isn’t harmful and that you have control over your emotions.
Medication can be used to temporarily control or reduce some of the symptoms of panic disorder, but do not treat or resolve the issue. While it can be useful in severe cases, it should not be the only treatment option pursued. They include:
- Antidepressants – they must be taken continuously as they take several weeks to begin to work.
- Benzodiazepines – Fast-acting anti-anxiety drugs (usually between 30 minutes to an hour) that provide rapid relief during an episode. They should be used with caution as they are highly addictive and have serious withdrawal symptoms.
- Learn about panic and anxiety so that you can feel normal about experiencing it and help yourself feel better about and control symptoms.
- Avoid smoking, alcohol and caffeine as they can trigger panic attacks in people who are susceptible.
- Learn how to control your breathing so as to develop a coping skill to use to calm yourself down when you begin to feel anxious. You will also be less likely to create the very sensations that you are afraid of.
- Practice relaxation techniques
- Connect face-to-face with family and friends
- Exercise regularly
- Get enough satisfying sleep
Post Traumatic Stress Disorder
Post traumatic stress disorder (PTSD) is a mental health problem some people develop after having witnessed or experienced a life-threatening event, such as sexual assault, a car accident and combat. While it is normal to have trouble sleeping, feel paranoid and have distressing memories after an event of this nature, the persistence of these symptoms longer than a few months might be indicative of PTSD. For some people, PTSD symptoms come much later on, or come and go after time.
If symptoms last longer than 4 weeks, cause you great distress, or impair your home or work life, you might have PTSD. There are 4 types of symptoms for PTSD, but the way in which they present themselves isn’t the same from person to person.
- Reliving/re-experiencing the event
- Avoiding people, places or situations that remind you of the event
- Increase in negative feelings and beliefs (guilt, loss of interest, numbness, shame, etc)
- Feeling especially “on edge” and hyper-arousal. You may be jittery and always on high alert.
People with PTSD also experience the following problems:
- Depression and anxiety
- Substance abuse
- Physical symptoms or chronic pain
- Employment and/or relationship problems
The idea of “getting better” means different things to different people. There are many treatment options available. Some experience the disappearance of all symptoms, while others experience fewer symptoms after treatment.
- Psychotherapy: meeting with a psychologist or psychiatrist. The most effective type of psychotherapy treatments for people with PTSD is cognitive behavioural therapy. Two of the many kinds of CBT are:
- Cognitive Processing Therapy (CPT) involves you learning skills to understand the effects the trauma has on you. Changing how you think about the trauma can change how you feel.
- Prolonged Exposure involves talking about the trauma repeatedly, until the memories are no longer distressing. This helps you gain control over how you feel about the trauma, and enable you to go back to exposing yourself to reminders of the trauma.
- A similar kind of therapy called Eye Movement Desensitisation And Reprocessing (EMDR) helps the brain work through traumatic memories by focusing on sounds or hand movements while recalling the trauma.
Medications for PTSD:
- Selective Seretonin Reuptake Inhibitors (SSRIs) and Seretonin Norepinephrine Reuptake Inhibitors (also used for depression) are effective when treating PTSD.
- Prazosin, for decreasing nightmares related to the trauma
- Benzodiazepines and atypical antipsychotics can be addictive and do not treat the core symptoms of PTSD and should thus generally be avoided for treating it.
MentalWealth® ZA does not provide medical advice, diagnosis or treatment.