What is Anxiety?

Anxiety is more than just feeling stressed or worried. While stress and anxious feelings are a common response to a situation where a person feels under pressure, it usually passes once the stressful situation has passed, or ‘stressor’ is removed.

Anxiety is when these anxious feelings don’t subside. Anxiety is when they are ongoing and exist without any particular reason or cause. It’s a serious condition that makes it hard for a person to cope with daily life. We all feel anxious from time to time, but for a person experiencing anxiety, these feelings cannot be easily controlled.

Please note that the information in this section (or anywhere on this site) is not intended as a substitute for professional medical advice, so please see a qualified health provider if you have any health concerns.

Causes

As with depression, it’s often a combination of factors that can lead to a person developing anxiety.

Family history of mental health problems

People who experience anxiety often have a history of mental health problems in their family. However, this doesn’t mean that a person will automatically develop anxiety if a parent or close relative has had a mental illness.

Ongoing stressful events

Stressful events can also trigger symptoms of anxiety. Common triggers include:

  • job stress or job change
  • change in living arrangements
  • pregnancy and giving birth
  • family and relationship problems
  • major emotional shock following a stressful or traumatic event
  • verbal, sexual, physical or emotional abuse or trauma
  • death or loss of a loved one.

Physical health problems

Continuing physical illness can also trigger anxiety or complicate the treatment of either the anxiety or the physical illness itself. Common conditions that can do this include:

  • hormonal problems (e.g. overactive thyroid)
  • diabetes
  • asthma
  • heart disease

If there is concern about any of these conditions, ask a doctor for medical tests to rule out a medical cause for the feelings of anxiety.

Substance use

Heavy or long-term use of substances such as alcohol, cannabis, amphetamines or sedatives can cause people to develop anxiety, particularly as the effects of the substance wear off. People with anxiety may find themselves using more of the substance to cope with withdrawal-related anxiety, which can lead to them feeling worse.

Personality factors

Some research suggests that people with certain personality traits are more likely to have anxiety. For example, children who are perfectionists, easily flustered, lack self-esteem or want to control everything, sometimes develop anxiety during childhood or as adults.

Everyone is different and it’s often a combination of factors that can contribute to a person developing anxiety. It’s important to note that you can’t always identify the cause of it or change difficult circumstances.

The most important thing is to recognise the signs and symptoms of anxiety and to seek help. The sooner you seek help, the sooner you can recover.

Signs & Symptoms

The symptoms of anxiety are sometimes not all that obvious as they often develop gradually and, given that we all experience some anxiety at some points in time, it can be hard to know how much is too much.

Some common symptoms include:

  • hot and cold flushes
  • racing heart
  • tightening of the chest
  • snowballing worries
  • obsessive thinking and compulsive behaviour.

These are just some of a number of symptoms that may be experienced. If you are familiar with any of these symptoms, check the more extensive list of symptoms common to the different types of anxiety disorders below. They are not designed to provide a diagnosis – for that you need to see a doctor – but they can be used as a guide.

Generalised anxiety disorder

For 6 months or more, on more days than not, have you:

  • felt very worried
  • found it hard to stop worrying
  • found that your anxiety made it difficult for you to do everyday activities (e.g. work, study, seeing friends and family)?

If you answered yes to all of these questions, have you also experienced 3 or more of the following:

  • felt restless or on edge
  • felt easily tired
  • had difficulty concentrating
  • felt irritable
  • had muscle pain (e.g. sore jaw or back)
  • had trouble sleeping (e.g. difficulty falling or staying asleep or restless sleep)?

Phobias (specific and social)

Have you felt very nervous when faced with a specific object or situation? For example:

  • flying on an aeroplane
  • going near an animal
  • receiving an injection
  • going to a social event?

Have you avoided a situation because of your phobia? For example, have you:

  • changed work patterns
  • not attended social events
  • avoided health check-ups
  • found it hard to go about your daily life (e.g. working, studying or seeing friends and family) because you are trying to avoid such situations?

Panic disorder

Within a 10 minute period have you felt 4 or more of the following:

  • sweaty
  • shaky
  • increased heart rate
  • short of breath
  • choked
  • nauseous or pain in the stomach
  • dizzy, lightheaded or faint
  • numb or tingly
  • derealisation (feelings of unreality) or depersonalization (feeling detached from yourself or your surroundings)
  • hot or cold flushes
  • scared of going crazy
  • scared of dying?

If you answered yes to all of these questions, have you also: felt scared, for 1 month or more, of experiencing these feelings again?

Post-traumatic stress disorder

Have you:

  • experienced or seen something that involved death, injury, torture or abuse and felt very scared or helpless?
  • had upsetting memories or dreams of the event for at least 1 month?
  • found it hard to go about your daily life (e.g. work, study, getting along with family and friends)?

If you answered yes to all of these questions, have you also experienced at least 3 of the following:

  • avoided activities that remind you of the traumatic event
  • had trouble remembering parts of the event
  • felt less interested in doing things you used to enjoy
  • had trouble feeling intensely positive emotions (e.g. love or excitement)
  • thought less about the future (e.g. about career or family goals)?

and have you experienced at least 2 of the following:

  • had difficulties sleeping (e.g. had bad dreams, or found it hard to fall or stay asleep)
  • felt easily angered or irritated
  • had trouble concentrating
  • felt on guard
  • been easily startled?

Obsessive compulsive disorder

Have you:

  • had repetitive thoughts or concerns that are not simply about real life problems (e.g. thoughts that you or people close to you will be harmed)
  • Done the same activity repeatedly and in a very ordered, precise and similar way each time e.g.:

    • constantly washing your hands or clothes, showering or brushing your teeth
    • constantly cleaning, tidying or rearranging things at home, at work or in the car in a very particular way
    • constantly checking that doors and windows are locked and/or appliances are turned off
  • felt relieved in the short term by doing these things, but soon felt the need to repeat them
  • recognised that these feelings, thoughts and behaviours were unreasonable
  • found that these thoughts or behaviours take up more than 1 hour a day and/or interfered with your normal routine (e.g. working, studying or seeing friends and family)?

Types of Anxiety

Generalised anxiety disorder (GAD)

A person feels anxious on most days, worrying about lots of different things, for a period of six months or more.

Social phobia

A person has an intense fear of being criticised, embarrassed or humiliated, even in everyday situations, such as speaking publicly, eating in public, being assertive at work or making small talk.

Specific phobias

A person feels very fearful about a particular object or situation and may go to great lengths to avoid it, for example, having an injection or travelling on a plane. There are many different types of phobias.

Obsessive compulsive disorder (OCD)

A person has ongoing unwanted/intrusive thoughts and fears that cause anxiety. Although the person may acknowledge these thoughts as silly, they often try to relieve their anxiety by carrying out certain behaviours or rituals. For example, a fear of germs and contamination can lead to constant washing of hands and clothes.

Post-traumatic stress disorder (PTSD)

This can happen after a person experiences a traumatic event (e.g. war, assault, accident, disaster). Symptoms can include difficulty relaxing, upsetting dreams or flashbacks of the event, and avoidance of anything related to the event. PTSD is diagnosed when a person has symptoms for at least a month.

Panic disorder

A person has panic attacks, which are intense, overwhelming and often uncontrollable feelings of anxiety combined with a range of physical symptoms. A person having a panic attack may experience shortness of breath, chest pain, dizziness and excessive perspiration. Sometimes, people experiencing a panic attack think they are having a heart attack or are about to die. If a person has recurrent panic attacks or persistently fears having one for more than a month, the person is said to have panic disorder.

Many people with anxiety experience symptoms of more than one type of anxiety disorder, and may experience depression as well.

It is important to seek help early. Symptoms may not go away on their own. If they are left untreated, they can start to take over the person’s life. Not only can anxiety affect the person with the disorder, but it can also affect the people close to them. As with depression, untreated anxiety can contribute to serious relationship and family problems, difficulty finding and holding down a job, and drug and alcohol problems.

Treatments

There are many health professionals and services available to help with anxiety information, treatment and support, and there are many things that people with anxiety can do to help themselves.

In addition to traditional health professional approaches, there are also a number of effective online therapies which can assist and treat anxiety disorders. Many of these are free, anonymous and easily accessible for anyone with internet access.

Effective treatment helps people with anxiety to learn how to control the condition so it doesn’t control them. The type of treatment will depend on the type of anxiety being experienced. Mild symptoms may be relieved with lifestyle changes (e.g. regular physical exercise) and self-help (e.g. online e-therapies). Where symptoms of anxiety are moderate to severe, psychological and/or medical treatments are likely to be required.

Psychological Treatments

Psychological treatments (talking therapies) have been found to be an effective way to treat anxiety. They may not only help a person to recover, but can also help to prevent a recurrence of anxiety.

There are several different types of psychological treatments, including cognitive behaviour therapy (CBT) and behaviour therapy. These psychological therapies can be undertaken with a professional, and increasingly, via structured sessions delivered via the internet (with or without support from a professional).

Cognitive behaviour therapy (CBT)

CBT is a structured psychological treatment, which recognises that a person’s way of thinking (cognition) and acting (behaviour) affects the way they feel. In CBT, a person works with a professional to look at the patterns of thinking and acting that are either predisposing them to anxiety, or keeping them from improving once they become anxious. Once these patterns are recognised, the person can consciously and deliberately make changes to replace these patterns with new ones that reduce anxiety and enhance their coping skills.

For example, thinking that is focuses on catastrophising (thinking the worst, believing something is far worse than it actually is, anticipating things will go wrong) is often linked with anxiety. In CBT, the person works to change these patterns to use a way of thinking that is more realistic and focused on problem-solving. Anxiety is also often heightened when a person actively avoids the things of which he/she is afraid. Learning how to face up to situations that are anxiety-inducing is also often helpful.

Professionals may use a range of techniques in CBT. Examples include:

  • Encouraging people to recognise the difference between productive and unproductive worries, teaching people how to let go of worries and solve problems.
  • Teaching relaxation and breathing techniques, with muscle relaxation in particular, to control anxiety and the physical symptoms of tension.

CBT can be conducted one-on-one with a professional, in groups, or online (see below). CBT is often combined with behaviour therapy.

Behaviour therapy

Behaviour therapy is a major component of cognitive behaviour therapy (CBT). However, it is different to CBT because it focuses exclusively on increasing a person’s level of activity and pleasure in their life.

Anxiety problems often persist because the person avoids fearful situations. Avoiding these situations means that the person does not have the opportunity to learn that he/she can actually cope with the fear. Behaviour therapy for anxiety relies mainly on a treatment called ‘graded exposure’. There are a number of different approaches to exposure therapy, but they’re all based on exposing people to the specific things that make them anxious. The person learns that their fear will diminish without having to dodge the need to avoid or escape the situation and that their fears about the situation often do not come true or are not as bad as they thought.

E-therapies

E-therapies, also known as online therapies or computer-aided psychological therapy, can be just as effective as face-to-face services for people with mild to moderate anxiety. CBT and behaviour therapy are helpful for anxiety when delivered by a professional. The structured nature of these treatments means they are also well suited to being delivered electronically.

Most e-therapies teach people to identify and change patterns of thinking and behaviour that might be keeping them from overcoming their anxiety. An individual works through the program by themselves, and although e-therapies can be used with or without help from a professional, most programs do involve some form of support from a therapist. This can be via telephone, email, text, or instant messaging, and will help the person to successfully apply what they are learning to their life.

This online mode of delivery has several advantages. It:

  • is easy to access
  • can be done from home
  • can be of particular benefit for people in rural and remote areas
  • can be provided in many cases without having to visit a doctor.

You can visit the Australian Government’s mindhealthconnect website to find a library of online programs.

Physical Treatments

Research shows that psychological therapies are the most effective in helping people with anxiety. However, if symptoms are severe, some medical treatments may be helpful.

Antidepressant medication

Some types of antidepressant medication can help people to manage anxiety, even if they are not experiencing symptoms of depression.

esearch indicates that when people have an anxiety disorder, there are specific changes that occur in the brain’s chemicals – serotonin, noradrenaline and dopamine. Antidepressant medication is designed to correct the imbalance of chemical messages between nerve cells (neurones) in the brain. Learn about the different classes of antidepressant medication.

What are the side effects?

Like any other medication, some people who take antidepressant medication experience some side effects. While they can vary depending on which medication is taken, common side effects can include nausea, headaches, anxiety, sweating, dizziness, agitation, weight gain, dry mouth and sexual difficulties (e.g. difficulty becoming/staying aroused).

Some of these side effects are short-lived, but there are still ways of minimising them so keep the doctor informed.

How long are antidepressants usually needed?

Like any medication, the length of time a person needs to take antidepressants for depends on the severity of their illness and how they respond to treatment. Some people only need to take them for a short time, while others may need them on an ongoing basis to manage their condition. It’s just like someone who uses insulin to manage their diabetes, or ventolin for asthma.

Antidepressants are safe, effective and not addictive. People sometimes want to stop taking antidepressants quickly because they are concerned they’re addictive. This may be because they confuse them with other types of medications (e.g. benzodiazepines, sedatives), but stopping medication should only be done gradually, on a doctor’s recommendation and under supervision.

Benzodiazepines

Benzodiazepines (sometimes called sedatives) are a class of drug commonly prescribed in the short term to help people cope with anxiety and panic attacks. Benzodiazepines reduce tension without making people drowsy but they are not recommended for long-term use as they can be addictive. They may be useful for a short period of time (two or three weeks) or if used intermittently as part of a broad treatment plan, but not as the first or only treatment.

Changes to scheduling of alprazolam by 1 February 2014

Alprazolam is a benzodiazepine drug most commonly used in the treatment of panic disorder and short term treatment of anxiety. From 1 February 2014 there will be a change to the way alprazolam is prescribed and supplied throughout all of Australia which your doctor and pharmacist are legally required to follow.

Helpful Contacts

Information and help lines

National

Reconnexion
1300 273 266 or (03) 9886 9400

Information and support service line available from Monday to Friday, 9am to 5pm.

Anxiety Recovery Centre Victoria (ARCVic)
1300 269 438 or (03) 9830 0533

Support, information and referral line for mental health care providers, people with anxiety and their families and carers. Available from Monday to Friday, 10am to 4pm.

ACT

Mental Health Foundation
(02) 6282 6658

Information and referral line available from Monday to Friday, 9am to 5pm.

NSW

Anxiety Disorders Information Line
1300 794 992

Information and referral line, available from Monday to Friday, 9am to 5pm.

VIC

Anxiety Disorders Association of Victoria Inc (ADAVIC)>
(03) 9853 8089

Telephone support and information service available Wednesday to Friday, 10.30am to 4pm. Closed on public holidays and weekends.