Anxiety is one of the most common mental disorders. If you or someone you know is struggling with anxiety there are ways to get help. In this article you can learn about anxiety, and some of the options to get help.

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The first thing you need to know is that anxiety is naturally related to being human! Our brain is made so that we experience a so-called fear reaction when we somehow feel threatened.

 

The fight / flight response

For example, imagine going on a mountain hike. The sky is blue and the air is clear, and you are enjoying your way downwards. In a fraction of a second, you discover that there is a small snake on the road, right where your foot is about to step. What will happen now? Well, it's probably no surprise that you jump for fear! And if you are lucky, this happens so fast that you have already made a big jump far away from the snake, and this even before you had time to reflect around the situation!

How do you feel afterwards? Well, you'll probably feel quite upset and your heart is pounding. You may feel numb in your body, your skin has become whiter, and all the peace and harmony you just felt has been replaced by a nasty feeling of uneasiness. But since you knew the reason why you were so scared, you shake it off. Go on, and you will feel better in a little while. 

The example above shows how the fear response, happens completely automatically and is actually a very good and useful feature to have! It shows us that fear is a protective function, and that it is often triggered so quickly that we only afterwards realize what has happened.

This response has been described as "fight-or-flight" response in the scientific literature [Cannon, 1915][1] .

But what if we get a similar reaction without knowing why?

Well, this is the difference between anxiety and fear. There are in fact many who have anxiety disorders who say that they do not know why they are anxious. At the same time, they can describe feeling a nasty feeling of restlessness, palpitations, sweating, numbness, stomach ache, and so on. For some, the feeling of anxiety becomes so strong that we say they have had one panic attacks. Many people who experience this will later walk around and feel an anxiety to get a new anxiety attack. Thus, they are in a vicious circle.

For others, the anxiety is different. Some people become anxious about being in situations with other people (social anxiety), some people worry a lot (generalized anxiety), some become very afraid of very specific things, e.g. spiders (we call this a specific phobia / phobic anxiety), while others keep the anxiety in check by doing certain actions over and over again, or thinking certain thoughts over and over again (we call this an obsessive-compulsive disorder; OCD). 

 

Why do you get anxiety?

To sum up so far: We all experience fear from time to time, which is healthy and normal. The difficult part is when the fear is prolonged, excessive, and you are not sure what causes the anxiety. Or in other cases: You might know some causes of the anxiety, but the fear do not resolve over time. 

Physically, anxiety and fear are exactly the same, and all people experience from time to time to be afraid. Anxiety disorders, however, indicate that the levels of fear significantly interfere with daily functioning levels and quality of life.

It is not known today what causes some people to develop anxiety. It is probably the case that some people have a congenital vulnerability in relation to developing such forms of reactions [Torgersen, 1983][2] . Anxiety disorders may not be directly congenital, but when people with a heightened vulnerability for anxiety are exposed to external influences, they are more likely than others to develop anxiety disorders.

External factors that can contribute to the development of anxiety disorders can be many. Psychodynamic explanatory models [Keefe et al., 2014][3]  are concerned with anxiety as a reaction to unconscious impulses that the individual try to express without succeess. Learning theory explanations [Mineka & Zinbarg, 2006][4]  emphasize that these are reactions that a person has learned through their own experience or by seeing how others react. Cognitive explanations [Otte, 2011][5] emphasize that anxiety reactions occur as a result of misinterpretations of the body's signals, which in turn leads to inappropriate thoughts.

In addition, it is known that traumatic experiences can easily lead to the development of anxiety disorders [Heim & Nemeroff, 2001][6] , in which dissocation, flashbacks, and the like, may play an important part of the condition.

  

Useful to know about anxiety

The anxiety reaction contains the following elements:

 

  1. Physical reactions: physical activation prepares people for "fight or flight" by the heart beating faster, more blood is directed to the muscles, more sugar is released in the blood, breathing goes faster, oxygen uptake increases, the muscles get tense, you sweat and may feel the urge to urinate, or get diarrhea. All this is due to the secretion of stress hormones and the activation of the autonomic nervous system. With persistent anxiety, this activation becomes uncomfortable (and very unpractical) and often leads to muscle pain, or it develops into an anxiety for anxiety (i.e., typically seen in panic attacks).
  2. Behavior: The behavioral reactions are most often that one either avoid the fear-provoking situation or becomes paralyzed ("freeze response").
  3. Thoughts: The mental reactions consist of assumptions about threat, danger and disaster.
  4. Emotions: The emotional reactions consist of the subjective experience of anxiety, panic, horror and fear.

Source: [SML, 2020][7]

 

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How common are anxiety disorders?

Anxiety disorders are among the most prevalent psychiatric conditions, with combined lifetime prevalence near 17% [Somers et al., 2006][8] .

 

Different types of anxiety

There are different types of anxiety. Here are the most important:

  •  means that one feels discomfort or anxiety in meeting other people. It may also be that you have anxiety only in meeting certain groups of people or in certain situations.
  •  means that one is afraid of spiders, planes, birds or great heights, for example. The fear is so strong that you make an effort to avoid what creates fear and you can be hampered in your daily life.
  •  means that you get palpitations and sweating. Many are afraid of fainting, suffocation or death. The fear of new seizures can make you isolate yourself at home.
  •  means that one is afraid of leaving home and moving out into areas that one perceives as unsafe, especially open spaces and places with many people.
  •  means excessive worries about everyday events. In addition, you often have a lot of muscle tension and inner turmoil.
  • means that you get unwelcome and unpleasant thoughts or images in your head. Rituals or compulsions are used to chase away the thoughts and images. Many people feel ashamed of the obsessions.
  •  occurs as a reaction to a mentally painful event or many strains over a long period of time. "Flashbacks" or nightmares where you relive the pain are common, avoiding the place the experience took place as well. Other symptoms include tension, drowsiness, anger and difficulty sleeping.
  •  is excessive health anxiety or disease anxiety. Characteristic is persistent concern that one may have serious physical (somatic) diseases.

 

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What helps with anxiety?

How anxiety is treated depends on the type of anxiety disorder in question. Also, there are different types of therapy that might be effective in the treatment of anxiety disorders. Anxiety should be treated by a psychologist, psychiatrist or others who are trained in such treatment. Anxiety disorder rarely recovers on its own.

 

Cognitive-behavioral therapy (CBT)

The general principle in CBT of anxiety disorders is that it largely consists of teaching the patient to cope with or master the anxiety, as opposed to completely "removing" it. CBT has been found to be effective in the treatment of several anxiety disorders, including panic disorder, generalized anxiety disorder, social anxiety disorder, obsessive-compulsive disorder, and post-traumatic stress disorder [Otte, 2011] .

Many professionals treat anxiety by exposing the person to what he / she experiences as anxiety-provoking; however, under supervision and guidance. This is done so that the person will experience that the dreaded object / situation does not represent a real danger. It is an aim to help the person interpret their bodily experiences more constructively, to stop their own inappropriate thoughts, and help them experience that anxiety attacks turns themselves off automatically if you do not fight back. This is because a panic attack is driven not only by fear, but also by the persons reactions to fear.

A potent form of anxiety is panic disorder / panic attacks. So to speak, panic attacks is the psyche's natural atomic bomb, and the affected person may stop the "nuclear reaction" by a more accepting and unworried perspective on a potentially "beginning" panic attack. However, treatment with CBT is generally found to have positive effect [Otte, 2011] .

 

Psychodynamic therapy 

In psychodynamic theory, anxiety symptoms are often assumed to originate from relationship experiences in which certain feelings or wishes were experienced by the patient as painful, dangerous, or unacceptable, such as feelings of loss or abandonment, a wish to express anger or assert oneself [Keefe et al., 2014] . Psychodynamic therapists encourage the patient to discuss the contexts in which their symptoms arise in order to understand the experiences surrounding the occurrence of symptoms.

Recent randomized controlled trials (RCTs) suggest that psychodynamic therapy may be useful in the treatment of anxiety disorders [Keefe et al., 2014] .

 

Medication

Medication for anxiety can alleviate the symptoms, but does not take away the anxiety. When the medication is stopped, the symptoms are likely to return. Thus, anxiety medication is rarely recommended as the only form of treatment. On the contrary, many therapists believe that in order to be sure that treatment is successful, the patient should not be medicated during treatment. However, there are divided opinions about this. Talk to your therapist about this if you are not sure what to do.

 

General consideration

Anxiety is one of the mental disorders with a relatively high treatment optimism. Research shows that anxiety is one of the disorders treatment is most effective against. In particular, the combination of cognitive and behavioral therapy (exposure training) proves to be effective.

 

Different types of help

Therapy is not the only way to get help for anxiety problems. Here is a list of measures that might be benefitial in the recovery process:

 

  1. Psychotherapy

     

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    Psychotherapy / treatment is a process characterized by a time-limited contact between a therapist and a patient / client, in which specific problems are thematized and worked with. Include different therapeutic traditions (for example cognitive behavioral therapy (CBT), psychodynamic therapy, family therapy, and more)

    A useful source that evaluate the effectiveness of specific therapies for different mental health problems is the website to the Cochrane Institute [Cochrane Institute][9] .

     

  2. Online therapy

     

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    Online therapy is similar to traditional therapy or treatment, but is provided by digital means (either phone, video conference, or similar). Digital interventions can include a broader range of options, such as therapist-guided self-help programs online.

    The current research literature provide strong support for the adoption of online psychological interventions as a legitimate therapeutic activity [Barak et al., 2008][10] .

     

  3. Support / self-help groups

     

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    Support / self-help groups can take a variety of forms, from providing a safe and supportive social environment; more or less structured group meetings; information and guidance relating to how to use available help services; and a lot more.

    While it is difficult to know the effectiveness of such services, due to very different compositions of support and self-help services, the research generally show the self-help groups may have important benefits for the participants [Kurouz et al., 2002][11] .

     

  4. Helplines and chats

     

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    Different helplines and chats exist. Some helplines are specialized in providing you with information and guidance, while others are more specialized in providing emotional support. Some helplines are highly professional, while others are more based on voluntary workers, that merely wish to be a caring listener.

    It is difficult to evalute how effective such services are, and it probably depends on many factors. For example, while the state of the science regarding the effectiveness of crisis response services remains limited, overall results provide support for such services [Hoffberg et al, 2020][12] .

     

  5. Online communities and forums

     

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    Online communities and forums are options to get in contact with other individuals that struggle with something similar to you or someone you know. Some communities are moderated by professional health workers, while most of them are not.

    Online communities is traditionally not understood as a support or health service, but rather a social area - that may have the potential of being supportive for the individual that uses it. Importantly, research has shown that "people with serious mental illness report benefits from interacting with peers online from greater social connectedness, feelings of group belonging and by sharing personal stories and strategies for coping with day-to-day challenges of living with a mental illness. Within online communities, individuals with serious mental illness could challenge stigma through personal empowerment and providing hope. By learning from peers online, these individuals may gain insight about important health care decisions, which could promote mental health care seeking behaviours" [Naslund et al., 2016][13] .

    This seems to indicate that online communites should not be underevaluated as a potential resource to recovery, coping and enhanced quality of life for people affected by mental health problems.

     

 

Find help for anxiety where you live

Please choose your location to find help for anxiety where you live:

 

You can also browse from different options of help where you live:

 

References & Footnotes
  1. Cannon, 1915: Cannon, W. B. (1915). Bodily changes in pain, hunger, fear, and rage. D. Appleton and company.
  2. Torgersen, 1983: Torgersen, S. (1983). Genetic factors in anxiety disorders. Archives of general psychiatry40(10), 1085-1089
  3. Keefe et al., 2014: Keefe, J. R., McCarthy, K. S., Dinger, U., Zilcha-Mano, S., & Barber, J. P. (2014). A meta-analytic review of psychodynamic therapies for anxiety disorders. Clinical Psychology Review34(4), 309-323.
  4. Mineka & Zinbarg, 2006: Mineka, S., & Zinbarg, R. (2006). A contemporary learning theory perspective on the etiology of anxiety disorders: it's not what you thought it was. American psychologist61(1), 10.
  5. Otte, 2011: Otte, C. (2011). Cognitive behavioral therapy in anxiety disorders: current state of the evidence. Dialogues in clinical neuroscience13(4), 413.
  6. Heim & Nemeroff, 2001: Heim, C., & Nemeroff, C. B. (2001). The role of childhood trauma in the neurobiology of mood and anxiety disorders: preclinical and clinical studies. Biological psychiatry49(12), 1023-1039.
  7. SML, 2020: Angst [Anxiety]. Store medisinske leksikon (SML). Retrieved 9th of February 2021 from: https://sml.snl.no/angst
  8. Somers et al., 2006: Somers, J. M., Goldner, E. M., Waraich, P., & Hsu, L. (2006). Prevalence and incidence studies of anxiety disorders: a systematic review of the literature. The Canadian Journal of Psychiatry51(2), 100-113.
  9. Cochrane Institute: Cochrane Institute: "Trusted evidence. Informed decisions. Better health." Retrieved 9th of February 2020 from: https://www.cochrane.org/
  10. Barak et al., 2008: Barak, A., Hen, L., Boniel-Nissim, M., & Shapira, N. A. (2008). A comprehensive review and a meta-analysis of the effectiveness of internet-based psychotherapeutic interventions. Journal of Technology in Human services26(2-4), 109-160.
  11. Kurouz et al., 2002: Kyrouz, E. M., Humphreys, K., & Loomis, C. (2002). A review of research on the effectiveness of self-help mutual aid groups. British Journal of Clinical Psychology33, 198-200.
  12. Hoffberg et al, 2020: Hoffberg, A. S., Stearns-Yoder, K. A., & Brenner, L. A. (2020). The effectiveness of crisis line services: A systematic review. Frontiers in public health7, 399.
  13. Naslund et al., 2016: Naslund, J. A., Aschbrenner, K. A., Marsch, L. A., & Bartels, S. J. (2016). The future of mental health care: peer-to-peer support and social media. Epidemiology and psychiatric sciences25(2), 113-122.