Anxiety (worry, social anxiety, panic, school refusal, trauma and OCD)

How is anxiety different to everyday fears?

Anxiety can be thought of as the discomforting inner experience that accompanies uncertainty. In contrast to fear, best categorised as one’s instinctual reaction to threats happening in the moment, anxiety is most commonly associated with dread over anticipated events (APA, 2015). Anxiety is innate to our humanity and is part of the way as humans we process many situations (Leahy, 2010). Certain types of experiences in response to threats can be considered anxiety disorders when the level of anxiety experienced significantly interferes with day to day living (please note: diagnosis of disorders should be verified with a health professional such as a psychiatrist or a psychologist).

Generalised Anxiety Disorder - sometimes referred to as GAD

The focus of anxieties and threats in GAD are often about everyday matters of life and living in one’s own head. Everyday worries can include as health, finances, family, friendships and work. The presence of worry itself can have a compelling effect in GAD: worrying may be seen as a way to help one to solve problems and anticipate effectively the bad things that may happen in the world, yet when experienced all the time, can feel overwhelming, exhausting and uncontrollable. So in GAD, often having to sit with your thoughts can be threatening, often turning the act of trying to fall asleep into a troubling experience.

Treatment for worry and Generalised Anxiety Disorder

Cognitive behaviour therapies often focus on providing a repertoire of ways to manage fears of living within your own thoughts and subjective dread. CBT often does not waste time trying to convince people that events in the world are going to work out.

Social Phobia / Social Anxiety

The focus of anxieties and threats in social anxiety is that other people may have negative evaluations of your character. Often this becomes exposed when speaking to strangers, being observed performing tasks or speeches, and socialising in groups.

Treatment for social anxiety

Cognitive behaviour therapies for social anxiety focus particularly on attention and behaviour. This is because the anxiety is exacerbated by over-attention to how one is perceived and under attention to connecting with other people or the task at hand. This also extends into safety behaviours, which can be thought of as subtle behaviours people carry out to control their feelings in social situations; these safety behaviors often end up being addictive and perhaps unnecessary e.g. drinking alcohol, avoiding silences, mind-reading what others may be thinking.

As you can probably imagine, safety behaviours often need to be addressed, because even if people perceive that social situations have gone well for them, they chalk up their success to engaging in the safety behaviour rather than the idea that many people may often simply accept you for who you are and only evaluate mildly. In fact, many negative evaluations from others turn out to be in response to one’s safety behaviours. For example, people are often negatively evaluated for managing their social anxiety by talking too much, or by acting cool, or by putting on a front of arrogance.

Obsessive Compulsive Disorder

Obsessive compulsive experiences (OCD) involve (i) having a distressing thought that ‘intrudes’ into that brain and (ii) having to perform some ritual to alleviate the anxiety involved with having the thought. The thoughts are often inferences or possibilities far removed from reality, but are nonetheless compelling and highly distressing. Obsessive thoughts often result in a person often struggling with their mind in order to not experience them.

Treatment for OCD

Cognitive behavioural treatment involves Exposure and Response Prevention; rather than struggle with the thought, the attention and behavioural rituals associated with the thoughts are gradually whittled away so that the person is not enslaved to their thoughts.

Post Traumatic Stress Disorder

The key threat in PTSD is a reawakening and haunting of past experiences in the present day. PTSD involves re-experiencing past episodes of danger, abuse or neglect. It often involves a strong physiological response (hyperarousal), moving away from memories or reminders of what has occurred (avoidance) and being alert for these reminders occurring (hypervigilance). It is theorised that the memories have not been ‘processed, and are therefore stuck with associated danger and intense vulnerability.

Treatment for PTSD

Psycholgical treatment typically involves re-processing memories in a way that is safe. Additionally, it is often found that effective trauma treatment sees people learning valuable information about safety, trust, power and self-worth.

Specific Phobias

The key threat in phobias is an irrational or unreasonable fear to specific objects in the environment. These fears have a major impact on life. The anxiety can occur in anticipation of facing the object or in reaction to the object appearing.

Common examples include:

• Planes/flying
• Heights
• Blood
• Needles
• Animals: particularly spiders, snakes, insects or dogs
• Confined spaces, particularly lifts.

Treatment involves learning a way to diffuse the overwhelming emotion associated with the phobia through a) emotion management skills and b) gradually confronting areas of life where the fear shows up.

Panic Attacks, Disorder and Agoraphobia

In Panic Disorder the key threat is the loss of control that comes with panicky experiences. Panic disorder is different to having panic attacks. It primarily involves the fear of panic attacks occurring, particularly in places where it will be hard to escape (e.g. lecture rooms, movie theatres, planes, shopping malls). It typically involves checking the body often throughout the day in order to feel ready for more excessive anxiety. Its core feature is an excessive fear of fear itself.

What is agoraphobia?

Agoraphobia is thought to occur once a person continually controls their life in such a way that they do not tend to leave home in order to prevent panic attacks from occurring in an escapable environment.

Treatment for panic attacks, panic disorder and agoraphobia

Relaxation involving slow breathing has not been recommended by panic disorder experts since the early 2000’s. (Schmidt et al, 2000). Instead, treatment often focuses on small experiments and exercises that help people learn not to catastrophize in the face of normal fear and anxiety responses in the body. Over time the brain’s memory and anxiety activation system does not produce excessive anxiety, having learnt that the emotion of fear is no longer a threat to one’s being.

Separation Anxiety Disorder and associated school refusal

In separation anxiety the threat is detachment from safety inducing environments or people. Separation anxiety can be experienced by both children and adults. It involves strong distress when thinking about or attempting to separate from home or a specific attachment figure. It is a normal developmental experience for all humans at some point. Often school refusal can be traced back to this threat.

Understanding how anxiety works from a psychological perspective

Regardless of the source of anxiety, the following conditions tend to exacerbate suffering.

1. Low acceptance of uncertainty
2. Believing your thoughts about how you will not be able to cope in the future
3. Over-emphasis on making the world predictable and controllable
4. Continually avoiding the above threats

Good cognitive behaviour therapy tends to account for all four factors:

1. Learning to accept uncertainty more effectively
2. Learning to respond to catastrophic thinking with self soothing and flexibility
3. Learning to (partly) let go of control and perfectionism to cope
4. Gradually approaching and building confidence in situations of perceived threat

While this may sound somewhat jargon filled, a good mental health professional can guide you through these skills and hopefully assist with anxiety if it is an ongoing issue.