Anxiety disorders

What are anxiety disorders?

Anxiety disorder are a type of mental disorder which causes a person to become overly anxious about particular people, places, events or even objects. The person with anxiety disorder may have such debilitating symptoms that they do not have enjoyment in or quality of life.

Anxiety and fear are normal human sensations which occur at various times in life (prior to making a public speech, taking an exam, etc) which are temporary feelings that go away once the stressful or fear causing situation is over. But, a person who has anxiety disorder does not feel these feelings fleetingly, they experience fear and distress for intense and prolonged periods, for no obvious reason.

Anxiety disorders generally affect a person who has other mental disorder or physical illness (including substance or alcohol abuse). The other illness may hide symptoms or even make them worse. Sometimes the other illnesses need to be treated before the person can be treated for the anxiety disorder.

Anxiety disorders are diagnosed through the assistance of a qualified psychologist or psychiatrist, through a series of diagnostic assessment tools (including series of questions about symptoms and feelings).

There are five types of anxiety disorders plus specific phobias:

• Generalized anxiety disorder (GAD)
• Obsessive-compulsive disorder (OCD)
• Panic disorder (PD)
• Post-traumatic stress disorder (PTSD)
• Social phobia (or social anxiety disorder)

Facts about anxiety disorders

• Anxiety disorders are the most common mental disorder in Western nations such as Australia, USA and UK
• Around 20% of visits to doctors are related to anxiety disorders (including panic attacks), which may be interfering with their life
• Women are more likely to be affected the most in basically just about all the different types of anxiety disorders
• Taking some type of action will help you learn to reduce symptoms and give you some control over your anxiety disorder, which will help you recover
• The medications for anxiety disorders work quite effectively in many people who take them
• Some people cannot take any medication (as they get many intolerable side effects) – these people are good candidates for alternative/complementary treatments for anxiety disorders
• Soldiers who experience traumatic events in war conditions are highly likely to suffer from post-traumatic stress disorder (PTSD) and need to be treated

Symptoms of anxiety disorders

Symptoms of generalised anxiety disorder

• Difficulty in concentrating for long periods
• Dry mouth
• Feeling easily tired
• Fidgety
• Insomnia
• Irritable
• Restless
• Tense muscles (especially in back, neck and shoulders)
• Upset stomach

Symptoms of obsessive compulsive disorder

• Arranging everything to line up or be ordered in certain ways
• Counting, tapping, repeating certain words (or other behaviour) to reduce anxiety
• Excessive attention about what is lucky or unlucky
• Excessive double checking locks, appliances or switches
• Excessive thinking about religion or morals
• Excessive time spent washing or cleaning self, others or the house/work space
• Fear of being contaminated or of contaminating others
• Fear of causing harm to self or others
• Intrusive sexually explicit or violent thoughts
• Praying excessively or engaging in rituals triggered by religious fear

Symptoms of post traumatic stress disorder

Symptoms of post traumatic stress disorder can display as any or all of the following:

• Reliving the traumatic event through
  • Experiencing physical or emotional reactions when talking about or being reminded of the trauma
  • Feeling like the trauma is happening right now
  • Flashbacks or unwanted memories during the day or in dreams
• Avoidance, suppression or blocking the traumatic event
  • Blocking out thinking about the trauma if it pops in your head or if something reminds you of it
  • Feeling distant from people in your life
  • Feeling numb or detached
  • Feeling that you do not have a long future
  • Keeping away from anything that reminds you of the traumatic event
  • Losing interest in life
• Feeling on guard and alert at all times
  • Easily startled
  • Feeling irritable
  • Inability to concentrate properly
  • Inability to sleep properly
  • Losing your temper easily

Symptoms of social anxiety disorder

Symptoms of social anxiety disorder include:

• Avoidance of social situations that disrupts life
• Blushing or flushing of the face
• Clammy, sweaty hands
• Dry mouth
• Excessively self-consciousness and anxious in normal, everyday social situations
• Extreme fear of being watched and judged by people you do not know in a social setting
• Fear that other people with know you are nervous
• Fear that you will embarrass or humiliate yourself in front of other people
• Intense worry for a length of time before a social event
• Nausea or upset stomach
• Pounding heart and rapid breathing
• Shaking or trembling, which may cause your voice to sounds shaky or tremulous
• Sweating and feeling nervous

Symptoms of a panic attack

The different types of anxiety disorders have some differences in symptoms, but they all experience one thing in common – anxiety and panic. The following symptoms of a panic attack can occur in different combinations (some or all symptoms):

• Chest pressure / pain
• Choking sensation
• Dizziness / lightheadedness
• Extreme fear of dying
• Fear of losing control or doing something embarrassing
• Feeling very hot or having chills
• Feeling like going crazy
• Intense fear and panic
• Nausea
• Palpitations
• Pounding heartbeat
• Restlessness
• Shortness of breath – feeling like you can’s get enough air in your lungs
• Tightness in the throat
• Tingling / numbness in fingers especially but also feet
• Trembling
• Unreality feelings – a sensation of not being in your body, feeling “foggy” or in a waking dream

It is important to note that while these symptoms can be extremely uncomfortable, they are generally not life-threatening.

Causes of anxiety disorders

Researchers are not sure what causes anxiety disorders, but they do believe it could be due to a combination of factors (biological, psychological and environmental/sociological).

Scientists believe that the main factors in the development of anxiety disorders are:

Brain chemistry

Some scientists think that imbalances in the neurotransmitters in the brain (especially serotonin and maybe dopamine) may be an underlying cause of anxiety disorders, because when medications are use to balance the neurotransmitters, the symptoms often greatly relieved in many people.

Genetics

Research shows that anxiety disorders are hereditary and studies have shown that if an identical twin has an anxiety disorder, it is significantly likelier that the second twin will also develop an anxiety disorder than if the twins were non-identical (fraternal) twins.

Researchers believe that genetics may play a big role in causing an anxiety disorder to develop, especially if it is combined with certain life experiences, which may make the individual more likely to develop the anxiety disorder.

Life experiences

Researchers believe that there may be a causal relationship between anxiety disorders and long term exposure to abuse, violence and poverty (or even a combination of these factor). Some people may just be more susceptible to anxiety disorders due to their life experiences. More research is being carried out in this area.

Personality

Scientists think that the personality may play a part in the development of an anxiety disorder. Research shows that people with low self esteem and poor coping skills may be more likely to develop an anxiety disorder.

Prevention of anxiety disorders

Non-preventable risk factors

Research shows that there are some complex risk factors associated with the development of anxiety disorders:

• Brain chemistry – some people could be born with different brain chemistry, which means the neurons, neurotransmitters (especially serotonin) and hormones may not be function very effectively. This could cause them to develop an anxiety disorder at some stage in their life (or more than once). Scientists also believe that in some people who are not born with faulty brain chemistry, something triggers something in their brain chemistry to malfunction and this causes them to develop an anxiety disorder. If the levels of certain neurotransmitters are not balanced and healthy, this may lead to the development of an anxiety disorder. The neurotransmitters could become imbalanced due to a number of reasons, many of which are not easily preventable
• Gender – being female is a risk factor for all anxiety disorders (except for obsessive-compulsive disorder). Women are more frequently diagnosed with anxiety disorders, compared to men. This could have a genetic basis to it, or it could be that women are more likely to see a doctor about psychological problems and men may not be so likely
• Genetics – some people are just more predisposed to mental disorders through genetic factors. In addition to this, people with family members who have an anxiety disorder have a higher risk for getting one themselves
• Personality – it may be difficult to change one’s personality, but it could be possible to change one’s reaction to life events
• Life experiences – some people who have very poor life experiences (abuse, violence, poverty, isolation) and may not be able to prevent the development of an anxiety disorder. Some people just respond very differently to their stressful and/or traumatic events (which have a negative impact) in their life and may develop an anxiety disorder as a subsequence

Complications of anxiety disorders

There are complications of anxiety disorders, which can seriously impair quality of life:

• Constant fear – people who have any type of anxiety disorder may be so constantly fearful of everything that it prevents them from having a normal quality of life
• Depression – people who have anxiety disorders are more likely to also develop depression. Studies show that people with any of the different anxiety disorders are significantly more likely to have a depressive disorder (than people without an anxiety disorder)
• Digestive disorders – people who have an anxiety disorder are much more likely to develop a digestive disorder (such as IBS) or to have worsening of symptoms of any type of digestive disorder due to their constant anxious feelings, which cause a great deal of stress on the body
• Insomnia – people who have an anxiety disorder may find it very difficult to get to sleep and stay asleep due to the constant worry and fearfulness, so this means insomnia may occur

When to see a doctor about an anxiety disorder

A family doctor should be consulted if you have any of the symptoms associated with any of the anxiety disorders. Early treatment can help to reduce the fears and anxieties associated with anxiety disorders and help you maintain a much better quality of life.

People who have a diagnosed anxiety disorder need to see their doctor on a regular basis, especially if they are taking medication, to ensure the medication is still at the correct level or to adjust dosage.

Diagnosis of anxiety disorders

Anxiety disorders are initially diagnosed through the following tests:

• Medical history – the doctor will ask a series of questions about your symptoms: when they occur, how often, severity and duration, as well as when did the symptoms start, if any event triggered the symptoms and even if you drink coffee/energy drinks heavily as this can cause anxiety symptoms
• Physical examination – the doctor may also check your breathing and heart (with a stethoscope) for a general view of their health

If your doctor thinks you may have an anxiety disorder, s/he may send you to get an evaluation from a psychologist or psychiatrist to confirm the condition and to determine your treatment.

There are a number of other tests that can be done to check for an underlying reason for the symptoms, that may not be related to an anxiety disorder:

• Blood tests – there are a number of conditions (some are serious) which present with anxiety symptoms, so they need to be ruled out. In addition to this, deficiencies in certain nutrients can present with anxiety and these should be tested in the blood too (iron deficiency)

Conventional treatment of anxiety disorders

Conventional treatment uses a combination of a number of different types of therapy (including psychotherapy and medication).

Cognitive behavioural therapy (CBT)

Cognitive behavioural therapy (CBT) is a form of psychotherapy, which teaches the person with the anxiety disorder to re-train their thoughts and behaviour when they face a situation that brings out their intense anxiety symptoms and fears.

CBT often lasts about 12 weeks and it may be conducted individually or with a group of people who have similar problems. Group therapy is particularly effective for social phobia.

A combination of cognitive therapy and medications is usually the approach that is often used very successfully for people with anxiety disorders as it combines both treatments together.

Mindfulness acceptance

This therapy is a relatively new one, which is beginning to gain popularity with conventional medicine and alternative medicine alike.

Mindfulness acceptance therapy is about being present in the moment and relishing it for what it is without stressing about the past or worrying about the future. Mindfulness is about allowing yourself to experience a situation and to observe how it makes you feel without judgement, without worry and without stress. It is one way to help accept yourself and be less anxious.

General guidelines for mindfulness acceptance therapy

• Try to be kind to yourself and view yourself with compassion. Let go of any pre-conceived notions and approach this with an open mind. Don’t be too hard on yourself
• Try to direct your full awareness or attention to one aspect of the present
• Observe and describe the present moment. Try to see it for what it is, but do not evaluate or analyse it. Allow your senses to take in the reality of the situation and your internal processes
• Try not to judge yourself for whatever you are thinking, feeling or experiencing. If you start to judge yourself (should, should not, good, bad, nice, annoying) just move your mind back to just experiencing the situation and observing and describing it to yourself
• Observe your experience (your thoughts, emotions and physical sensations) without necessarily reacting to it it

Adapted from University of Melbourne’s mindfulness program guidelines.

Kabat- Zinn (1998), a pioneer of mindfulness based therapeutic approaches in the West, describes mindfulness as “paying attention, without judgement, to the experience of the present moment”.

Systematic de-sensitisation

This is a technique that tries to break the link between the stimulus that causes the anxiety and the anxiety response. This technique requires the patient to gradually confront the object of fear. There are three main objectives in the process of this technique:

• A list of anxiety producing situation in order of worst to least fearful
• The de-sensistisation procedure for each item on the list (above) starting from the least anxiety-producing item to the most
• Relaxation training strategy

Systematic de-sensitisation is especially useful for treating people with simple phobias, social phobias, agoraphobia and post-traumatic stress syndrome.

Meditation

Studies show that any type of meditation is beneficial for reducing anxiety symptoms. Meditation induces a more relaxed state of mind, which helps people with anxiety disorders to reduce the amount of fear, anxiousness and negative internal chatter to relax and feel calmer. One caution should be noted: meditation may not be so beneficial for some people with any type of psychosis as the meditation may trigger their psychosis.

Medication

There are a number of different types of medications that are used to treat anxiety disorders. Most medications will take anywhere from 2-12 weeks to start working and reach maximum effectiveness (this is also how long side effects should also take to be present):

• Atypical anti-psychotics – these medications are used to treat anxiety disorders which have associated psychoses, in which the person suffers hallucinations, delusion or just very confused thinking. Some research shows that atypical anti-psychotic medications may have a place in treating very severe anxiety. The new class of these drugs work on normalising the two neurotransmitters in the brain, serotonin and dopamine and have less side effects than the older class of atypical anti-psychotic medications and have been shown to be able to treat a number of anxiety disorders. Sometimes the atypical anti-psychotics are used in combination with SSRIs, at very low dosage. Most commonly atypical anti-psychotics are used to treat severe cases of post-traumatic stress disorder and also to treat some cases of obsessive-compulsive disorder. Some recent research also suggests that these drugs may be useful in treating people with other anxiety disorders, such as generalised anxiety disorder, agoraphobia and panic disorder which have not responded well to other treatments, or are severe. The atypical anti-psychotic medications have a number of side effects, which should be closely monitored (weight gain, reduce sex drive, muscle stiffness and restlessness). Examples of atypical anti-psychotics are: Risperidone (Risperdal^®), Olanzapine (Zyprexa^®), Quetiapine (Seroquel^®)
• Benzodiazepines – these are an anti-anxiety medication, which also have a mild tranquilising effect. Benzodiazepines quickly reduce anxiety within 15-20 minutes of taking them and can be used only when required (they do not need to be taken every day). Benzodiazepines are prescribed at a low and regular dose, but only for a short period (as they can be addictive). This class of drugs have relatively few side effects (compared with some other types of medications), but if taken long term, they can become addictive. People who become addicted to benzodiazepines become dependent on them just to feel normal and without taking this drug, they often feel worse than they did prior to starting to take it. Examples of benzodiazepines: Lorazepan (Ativan^®), Chlordiazepoxide (Librium^®), Oxazepam (Oxazepam^®), Diazepam (Valium^®), Alprazolam (Xanax^®),
• Beta blockers – these class of medication are used to lower blood pressure in people with anxiety disorders whose blood pressure may be raised higher than normal. Beta blockers work to reduce the effects of noradrenaline and norepinephrine, which may be raised higher than normal in people with anxiety disorders. Beta blockers may be used to reduce the symptoms associated with anxiety disorders, such as shaking, trembling, fast heartbeat, blushing. Beta blockers are primarily used to treat specific phobias such as social anxiety and performance anxiety. Examples of beta blockers are: Propranolol hydrochloride (Inderal^®), Atenolol (Tenormin^®)
• Monoamine oxidase inhibitors (MAOI) – these are the oldest class of anti-depressant medications and they should not be taken in combination with any type of SSRI drugs or St John’s Wort as the combination can produce serious (and fatal) side effects. MAOIs can produce serious side effects and their use must be strictly monitored to prevent this from occurring. People are often prescribed MAOIs when other types of anti-depressants have not worked to reduce symptoms. MAOI are the least often prescribed anti-depressants as they have such a large range of side effects and a restrictive diet needs to be followed when taking them. Examples of MAOIs are: Phenelzine (Nardil^®), Tranylcypromine (Parnate^®), Isocarboxazid (Marplan^®),People taking MAOIs should avoid the following food (to reduce possible adverse effects):
  • Alcohol
  • Avocados
  • Broad beans
  • Cheese (any type)
  • Fermented soy extract
  • Salami
  • Meat or yeast extract
  • Pickled herring
  • Food that is stale or going off, especially meat, fish, offal, poultry or game
• Mood stabilisers – these medications are normally prescribed for people with bipolar disorder, but when standard treatments for anxiety disorders do not work (other medications), doctors can prescribe these to try to help reduce symptoms. Examples of mood stabilisers are: Valproate (Epilim^®), Valproate Semisodium (Depakote^®), Carbamazepine (Tegretrol^®)
• Selective serotonin re-uptake inhibitors (SSRI) – these are a newer class of anti-depressant medications which alter the levels of serotonin in the brain (they increase the levels of serotonin to control mood) and to reduce anxiety symptoms. SSRIs were a recent anti-depressant medication development, only available from around 30 years ago. SSRIs are prescribed to help people who have the following anxiety disorders: agoraphobia, generalised anxiety disorder, obsessive-compulsive disorder, panic attacks, panic disorder, post-traumatic stress disorder, social phobias. These drugs can also produce side effects but these are usually milder in comparison to older antidepressants (MAOI) and side effects normally decrease after some time, for most people. Examples of SSRIs are: Citalopram (Cipramil^®), Fluvoxamine (Faverin^®), Paroxetine (Seroxat^®), Fluoxetine (Prozac^®), Sertraline (Lustral^®).
  SSRI should not be taken in combination with St John’s Wort, other anti-depressants, MAOI as they can cause a fatal reaction
• Tranquilisers – there are other classes of tranquilisers that can be prescribed (which are different to benzodiazepines) that can reduce anxiety symptoms very quickly. Some of these different types of tranquilisers may also have fever side effects than benzodiazepines. These tranquilisers are best when used over a short-term, should not be used with MAOIs and should not be used with alcohol. Examples of other tranquilisers are: Buspirone (Buspar^®), Hydroxyzine
• Tricyclics – these are an older type of anti-depressant medication which work as well as SSRIs for anxiety disorders, but they are not used for obsessive-compulsive disorder (OCD). Tricyclics help to increase levels of serotonin and norepinephrine which help to reduce anxiety symptoms. These drugs have some side effects which can usually be reduced by lowering the dose or changing to another type of tricyclic medication, but even despite this, a great number of people abandon this medication due to the side effects that they produce. Examples of tricyclics: Amitriptyline (Triptafen^®), Clomipramine (Anafranil^®), Dosulepin/Dothiepin (Prothiaden^®), Doxepin (Sinequan^®), Imipramine (Tofranil^®), Nortriptyline (Motival^®)

Alternative / complementary treatment of anxiety disorders

Alternative / complementary medicine treats not just the symptoms of anxiety disorders, but the underlying cause.

If you’re taking any type of medication, don’t try any alternative treatments without consulting your doctor about possible side effects

Herbs

There are a number of herbs which can help to reduce symptoms:

• Chamomile (Matricaria chamomilla) – the tea of the chamomile flower is relatively safe to take before going to bed (even for people taking medication for their anxiety). Chamomile has calmative properties which may help reduce mild to moderate symptoms of anxiety enough to allow sleep and may reduce some insomnia
• Passionflower (Passiflora incarnata) – the herb passionflower has been shown in a few studies to be as effective as the anti-anxiety medication, benzodiazepines for relieving anxiety symptoms
• St John’s Wort (hypericum forte) – the herb St John’s Wort has been extensively studied for its effect on depression and many studies have shown it to be effective in reducing symptoms in people with mild to moderate depression and in people with anxiety disorders. St John’s Wort is one of the most widely prescribed herbal medicine by doctors in Germany. It is gaining more popularity in other countries as the results from studies show it to be effective. People taking any type of anti-depressant or anti anxiety medications should not also use St John’s Wort as this combination could cause serotonin syndrome, which can be life threatening

Vitamins

There are a number of vitamins which are especially useful to help reduce symptoms associated with anxiety disorders:

• Vitamin B3 – the B vitamin, niacin is vital for the health of the nerves because a deficiency in this vitamin can result in symptoms such as confusion, memory loss and mood swings
• Vitamin B6 – the body requires adequate levels of vitamin B6 (pyridoxine) in order to properly synthesise tryptophan, the amino acid which is the precursor of serotonin. Serotonin is the neurotransmitter which regulates mood and calms the mind and adequate levels of vitamin B6 enable the proper synthesis of serotonin

Minerals

There are a number of minerals which are useful to help reduce symptoms associated with anxiety disorders:

• Calcium – the mineral calcium needs to be in a specific ratio with the mineral magnesium for optimal health (2:1), calcium: magnesium, otherwise an imbalance of high levels of calcium can cause anxiety, mood swings and other symptoms. Women are more likely to be taking calcium supplements, so they should ensure they are getting adequate magnesium at the correct ratio too
• Magnesium – the mineral magnesium is vital for relaxing the smooth and skeletal muscles of the body and is often recommended for any condition which causes tension in the body (and mind). Many studies show that magnesium helps to reduce anxiety, tension and depression as much as anti-anxiety medication. Studies also suggest that magnesium may play a role not just in reducing anxiety, but it also may have a protective effect on the brain after traumatic brain injury. In fact, deficiency of magnesium has been suggested as a trigger for some types of anxiety disorders. Foods rich in magnesium are: nuts, cereals, leafy green vegetables

Other nutrients

There are a number of nutrients which are especially useful to help reduce symptoms associated with anxiety disorders:

• GABA – the amino acid GABA is used by the body to produce a neurotransmitter that relaxes and calms the mind and balances the mood
• Omega-3 fatty acids – there is some evidence that the omega 3 fatty acids may help with people who have depression and anxiety, as they are necessary to ensure the membranes on the nerve cells are healthy and function properly. Since anxiety disorders may be due to imbalanced brain chemistry, it could be useful to ensure omega-3 fatty acids are topped up either in supplements, or by eating more oily fish (mackerel, salmon, sardines, trout, tuna) about 2-3 times a week
• SAMe – the substance S-adenosylmethionine is a naturally occurring molecule in the body which has been successfully used to help reduce anxiety and depression symptoms that people with anxiety disorders normally experience. SAMe is a precursor of serotonin
• Tryptophan – the amino acids tryptophan is a precursor to the important neurotransmitter serotonin, which regulates mood and helps ensure feelings are more balanced and calm, so it is used to help reduce anxiety and depression symptoms. Foods rich in tryptophan, include bananas, warm milk and turkey. To help with sleep, try some warm milk with honey about 30-60 minutes before bed

Dietary modifications

There are some dietary modifications which can be useful to help reduce symptoms associated with anxiety disorders:

• Add linseed oil or cod liver oil to the diet – both linseed oil and cod liver oil contain vital essential fatty acids (omega-3), which are beneficial for normal brain health. People taking any type of medication for their anxiety disorder should consult their doctor before trying either of these natural oils, to avoid possible adverse effects
• Avoid alcohol and drugs – while it may feel that alcohol and some types of drugs help to relax you and make the symptoms go away for a little while, they are just numbing anxiety and make the problems associated with anxiety disorders worse in the long run
• Avoid caffeine – this substance is know to make anxiety and fear worse in some people with anxiety disorders and it is especially advised to avoid it a few hours before bed-time to help reduce insomnia due to excessive caffeine
• Avoid MSG – this additive (monosodium glutamate) is used in many processed foods and is a known trigger for for anxiety in people who are more susceptible. The most common foods with MSG are: chips, crackers, dressing, gravy, instant noodles, instant soup, sauces, savoury snack foods, stock. Processed foods which have MSG are labelled with: flavour enhancer, E621, 621
• Avoid sugar and all refined foods – this is because high intakes of sugar and highly processed (take-away, junk) foods may cause a rapid rise in blood glucose levels and then another rapid fall (just soon after), which may interrupt the body so much that it can cause anxiety if the blood sugar levels are not quickly increased again. This not only affects anxiety levels, but can cause weight gain, which may further increase anxiety
• Certain foods induce calm – studies show that certain foods can create a more calmer mind and body, due to the nutrients they contain. The foods most recommended for a calmer and less anxious state are: asparagus, avocado, beetroot, carrots, eggs, oily fish, onions, paw paw, spinach, stone fruit
• Eat more egg yolks – organic egg yolks (about one per day) is highly recommended to increase intake of lecithin (phosphatidyl choline). Many studies show that lecithin helps the brain neurons and in particular, the dopamine neurotransmitters, function more effectively, which may help reduce symptoms in people with anxiety disorders

Lifestyle modifications

There are a number of lifestyle modifications that are used to help people overcome their anxiety symptoms:

• Breathing technique – these teach people with anxiety disorders how to breath properly by breathing more deeply, not over-breathing and to relax their mind and internal chattering of anxious thoughts to help reduce symptoms. Learning how to breath properly is a way of reducing hyperventilation
• Control your worrying – learn strategies to help control (or reduce) the anxious and fearful thoughts that are always on your mind
• Counselling – this involves talking about symptoms and fearful triggers with a psychologist/counsellor to learn better coping techniques and working out what the triggers for anxiety and fear are and learning to gradually overcome them. The best form of counselling therapy is cognitive behavioural therapy as it helps you to understand the triggers for your symptoms and helps you to understand why you feel the way you do in order to learn to change your thought patterns
• Exercise – all types of exercise are beneficial for all types of anxiety disorders (and depression). Exercise is a well known way to reduce symptoms of anxiety, as it release endorphins (“feel good” chemicals) and helps the body release toxins and it is a great way to lose weight or at least maintain a healthy body weight
• Relaxation techniques – this is a must for helping reduce anxiety symptoms as it is very effective in reducing anxiety symptoms overall. There are many different types of relaxation techniques, some of which use muscle relaxation, others use breathing control, while others use visualisation and some use a combination of all
• Sleep – make sure you have enough sleep each night and try to go to sleep and wake up around the same time each day to get a regular sleeping pattern going, which helps set the body clock (and assists with regulating many processes in the body)
• Yoga – this is a great way to control breathing (stop the over-breathing) and control the mind and body, which gives more confidence and reduction of symptoms. There are many forms of yoga, from the very vigorous to the more relaxing, meditation types

Alternative treatments

• Acupuncture – studies have shown that acupuncture may be beneficial for people with anxiety disorders to help reduce symptoms and is even more significantly beneficial when it is combined with some form of psychotherapy (cognitive behavioural therapy) to reduce symptoms and help with a better quality of life
• Massage – the benefits of a relaxing massage are significant for people with anxiety. A therapeutic massage can relax tension in the muscles and reduce a great deal of the anxiety in people with anxiety disorders (but this is only temporary, a massage cannot cure the condition, but it can provide temporary relief of symptoms)
• Meditation – this is way of calming the mind and relaxing the body by using various breathing and visualisation techniques. Meditation has shown to be very beneficial in many people to reduce the anxiety and fear symptoms of anxiety disorders even without any medication

Always ensure that you notify your medical practitioner of any supplements that you want to take – it may interfere with other medication or conditions you have. Confirm with your doctor it is safe to take before you try it.

Living with an anxiety disorder

People who have an anxiety disorder have a great number of strategies that they can use to help reduce the symptoms of these conditions, feel healthier and more in control of life.

General strategies to help deal with anxiety disorders

• Counselling – the best form of counselling for any type of anxiety disorder is cognitive behavioural therapy (CBT), which aims to change thought patterns from negative ones which do not help you, to more positive, or at least neutral ones, which do not have such a negative impact on your thinking or your actions
• Distract yourself – when you feel your worries and anxiety are getting too overwhelming, then it is time to distract yourself with something else that takes your focus away from your internal (and negative) chatter. The distraction works by re-focusing your attention on something else and allows your mind to stop the internal chatter because you need to put your energy into the new activity, which can be whatever you choose (cooking, walking, exercise, singing, painting)
• Exercise regularly – numerous studies show that people who exercise on a very regular basis (most days for at least 30 minutes) report having less anxiety, depression or mood swings. Exercise helps to release endorphins, which help to regulate mood, reduce anxiety and relax your internal chatter
• Good nutrition – proper nutrition is vital to ensuring the body is healthy and has a good basis to fight any type of illness or disease. Good nutrition means eating mainly fresh, unprocessed foods that consists of at least 2 portions of fruits, 5-7 portions of vegetables, some low fat dairy foods (milk, yoghurt or cheese), nuts and seeds, legumes, wholegrains, healthy fats (olive oil, avocado), oily fish 2-3 times a week and as small portion red meat 2-3 times a week. The good fats from olive oil, avocado, nuts, seeds and oily fish are really beneficial for people with any type of mental disorder, as they help to keep the brain healthy
• Let go of the past – it is impossible to change the past or even to worry about because it is done and nothing you can do can change it, no amount of worrying and anxiety will ever change any part of it, so you need to just let it go. Excessive worry about something that is able to be changed is a waste of your energy – use it for something more worthwhile
• Meditation – it is highly recommended for people with any type of anxiety disorder to engage in some form of daily meditation, as many studies show it helps to reduce feelings of anxiety and even depression. There are a number of different types of meditation that are available, so if you want to try it, you should be able to find something that suits you. For best effects, meditation should be done twice a day, every day (about 1/2 an hour) for about 2-3 months and then scaled down to once a day on a maintenance level
• Socialise – being around other people is necessary to stop people with most forms of anxiety disorders from feeling isolated and alone, which may just perpetuate symptoms even more. Call a friend, go out for a drink or to see a movie, something really simple and not too time or energy consuming as a starting point. This strategy may not work so well for people with social anxiety disorder, except under some treatment and other strategies
• Support group – there are a number of support groups for people with anxiety disorders everywhere, you just need to find one that suits you. Once in a group situation, you may start to realise that you are not alone, you are not the only one who has suffered from an anxiety disorder and you can make progression in your condition and have relief from symptoms
• Treatment plan – you need to make sure that you see your doctor (or other health professional) on a regular basis, to make sure that whatever medication (or supplements) you are taking are working and to determine if you need any adjustments in dosage. This helps you because when symptoms are not severe, you can feel more in control of yourself and your life, which in turn will help reduce your symptoms even more

Caring for someone with an anxiety disorder

Partner

People who have a partner with an anxiety disorder can help their partner through a number of strategies:

• Avoid alcohol – your partner needs to avoid social situations that include alcohol, because it can interfere with the medication they are taking, which may cause some adverse effects. Additionally, if you partner is not taking any medication, they should also avoid alcohol because their hang-over symptoms will be much worse the next day, especially the psychological symptoms, so try not to have alcohol in the home
• Encourage exercise – if you have similar interests as you partner, you can try to encourage them to exercise more by being their exercise buddy. There are many gyms and other exercise programs you can join together. If you don’t have similar interests, you can still encourage your partner to go to a gym or other exercise program with their friends
• Healthy diet – a healthy diet is an absolute must for anyone with an anxiety disorder. Try to limit all processed foods (junk and snack foods) and encourage your partner to eat lots of fresh fruit and vegetables, nuts, legumes, eggs, wholegrains, dairy (milk, yoghurt and cheese), fish and some red meat. Fish is especially recommended for children with any type of psychological disorder the omega-3 fatty acids help the brain function more correctly. Other good fats that can help the brain are: nuts, eggs, seeds, olive oil, avocado
• Support – most of all, your partner needs your support and encouragement to know that you are there for them. Let your partner know you are available for them to talk about their feelings and will not ridicule or demean them

Friends

People who have a friend with an anxiety disorder can help their friend through a number of strategies:

• Avoid alcohol – your friend needs to avoid social situations that include alcohol, because it can interfere with the medication they are taking, which may cause some adverse effects. Additionally, if you friend is not taking any medication, they should also avoid alcohol because their hang-over symptoms will be much worse the next day, especially the psychological symptoms. So try to engage with your friend in social situation where alcohol is not a major factor
• Encourage exercise – if you have similar interests as you friend, you can try to encourage them to exercise more by being their exercise buddy. There are many gyms and other exercise programs you can join together
• Support – most of all, your friend needs your support and encouragement to know that you are there for them. Let your friend know you are available for them to talk about their feelings

Parents

Parents who have a child with an anxiety disorder can help their child through a number of strategies:

• Exercise – encourage your child to engage in physical activity as this can help to reduce many of their symptoms, will ensure they have a healthy body weight and will increase their social skills (especially if it is a team sport with other children)
• Healthy diet – a healthy diet is an absolute must for anyone with an anxiety disorder. Try to limit all processed foods (junk and snack foods) and encourage your child to eat lots of fresh fruit and vegetables, nuts, legumes, eggs, wholegrains, dairy (milk, yoghurt and cheese), fish and some red meat. Fish is especially recommended for children with any type of psychological disorder the omega-3 fatty acids help the brain function more correctly. Other good fats that can help the brain are: nuts, eggs, seeds, olive oil, avocado
• Praise your child – when you can see that your child is making any progress in overcoming their anxieties, you can praise your child, as this is a great way of providing positive reinforcement to help your child get better
• Set a schedule and keep it – this is beneficial for children with any type of anxiety disorder, but especially for children with obsessive-compulsive disorder. Children with an anxiety disorder really need to have a schedule that they can rely on, which can keep them grounded and to help them feel more secure about their environment
• Support – most of all, your child needs your support and encouragement to know that you are there for them
• Validate your child – if your child feels anxious, worried or distressed in some way you can validate how they are feeling which can help to connect your child to their feelings and this may help them recognise these feelings as being negative and unnecessary. Examples of validating your child’s feelings are: “I can understand that you are feeling a little worried about …” or “You seem to be a little scared of …” where the blank part is whatever the child is worried/scared about.

References

Last reviewed and updated: 14 May 2024