Occasional anxiety is a normal part of life. But extreme fear or worry, panic attacks, phobias and an accelerated heart rate may signal something more serious.
Anxiety disorders are a common mental illness in South Africa. Approximately 1 in 5 South Africans are affected each year, according to the South African Depression and Anxiety Group (SADAG).1 Characterised by overwhelming worry and fear, anxiety disorders can keep you from functioning in your normal life and can be disabling.
They include panic disorder, social anxiety disorder, specific phobias, and generalised anxiety disorder (GAD) 2. Obsessive compulsive disorder (OCD) and post-traumatic stress disorder (PTSD) are also closely related to anxiety disorders.3
“GAD includes symptoms such as excessive worry and self-doubt that interferes with daily life and lasts for more than six months,” says Felicity Pienaar, occupational therapist at Akeso Clinic in Nelspruit. “Physical symptoms include trouble falling or staying asleep, muscle tension (clenching the jaw, balling your fists and tightening of muscles throughout the body), chronic indigestion and self-doubt.”
Pienaar explains that some people experience specific phobias, such as irrational fear of a situation or thing like crowds, flying or animals that are overwhelming, disruptive and out of proportion to the actual risk involved.
Others spend a lot of time thinking and worrying about being at a specific event where they will be in the spotlight or amongst a lot of people, and dwelling on it when it is over. They may experience self-consciousness, blushing, trembling, nausea, and difficulty talking and sweating when having to interact with others, even a small number of people.
People with OCD suffer from obsessive behaviour and may have anxiety about making mistakes or falling short of standards. They develop compulsive behaviour that may be cognitive (for example, needing to repeatedly tell themselves ‘it will be ok’) or physical (for example, repeated hand washing or straightening objects). This becomes a disorder when these ‘rituals’ drive their life.5
PTSD is a debilitating condition that follows a traumatic event. People are often plagued by frightening memories of the event, which trigger the condition. People struggling with PTSD may experience flashbacks, nightmares, numbing of emotions, depression and feeling angry, irritability or feeling distracted and being easily startled.7
A panic disorder is characterised by sudden attacks of panic and fear, and attacks are usually triggered by fear-producing events or thoughts, such as taking a lift or driving.4 Panic disorder results in physical symptoms, which include rapid heartbeat, strange chest sensations, and shortness of breath, dizziness, tingling, and anxiousness.5
Panic disorders typically start in young adulthood, but children and older people are not immune. Women are twice as likely to suffer from a panic disorder. People from all races and social classes experience panic disorders, although different cultures tend to express symptoms differently.6
“These issues can have a serious effect on all areas of a person’s life, resulting in them becoming unable to function in their day-to-day lives,” says Pienaar. “In serious cases, anxiety left untreated can derail careers, destroy relationships and may even drive a person to suicide.”8
What causes anxiety?
Anxiety disorders are caused by a number of different factors. No single situation or condition will cause it. Physical and mental triggers combine to create a certain anxiety disorder.7
“Experts believe that anxiety can sometimes be a learned behaviour that can be unlearned with the correct help,” says Pienaar. “Heredity plays a role, as does altered brain chemistry – indicated by the fact that symptoms respond to medication. The condition may also be exacerbated by personality and certain life experiences.”7
Overcoming avoidance behaviours
It is important to recognise that avoidance doesn’t work, Pienaar says.9, 10 Trying to avoid certain situations, thoughts or feelings often results in experiencing more of the thing you are trying to avoid, as the patient ends up constantly focusing on that one thing9. Instead, she advises the following:
- Recognise the cost of avoidance. Take note of the time and mental energy spent trying to avoid something. Ask yourself how it has affected your relationships and your view of yourself.
- Start learning to tolerate uncomfortable thoughts and feelings about situations. The more you are willing to expose yourself to thoughts and feelings that make you anxious, the more quickly they will pass naturally. Thoughts and feelings are temporary, and you need to learn to ‘ride them out’. Consciously relaxing your muscles and doing breathing exercise can help you to think more clearly.
- Use distraction techniques (cognitive distraction such as counting backwards in 3’s or 7’s, singing your favourite song or reciting your favourite poem), and mindfulness or progressive muscle relaxation.
- Aerobic exercise, in particular, releases endorphins (chemicals in the brain) that help you to feel more healthy and vital. They act as natural pain killers and improve our ability to sleep, which is very important to reduce stress.11
- Avoid stimulants. Substances such as caffeine and nicotine make one feel jittery and tense, and can worsen existing anxiety. We believe that it will calm our nerves, but the physical effect on our body is the opposite.
- Eat a balanced diet. Avoiding processed and high-sugar food can help manage your anxiety, as these foods cause fluctuations in blood sugar, which affects mood. This is followed by a ‘crash’, which can cause shaking and tension. These worsen anxiety.
- Getting enough sleep allows your body to regenerate and recharges your mind. After a good night’s sleep, coping with our problems becomes more manageable.
How friends and family can help12
- Educate yourself on the type of anxiety with which your loved one is struggling.
- Encourage them to seek professional help, be open to listening to them, but do not try to be their therapist.
- Let them know they can be open with you, and help them to acknowledge and accept their anxiety by assuring them that you do not see it as a weakness or a flaw.
- Don’t fall into the reassurance-seeking trap. If a loved one repeatedly asks for reassurance about what it is they fear (‘Are you sure it’s not cancer? ‘Are you sure you aren’t cross
with me?) they probably need help from a psychotherapist.
- Help them to face some of the things they are avoiding or putting off altogether due to anxiety. Help them to talk through the steps they need to take in order to do that which they are avoiding, and encourage them to take the first step.
- Encourage exercise, as well as doing meditation/mindfulness and breathing exercises together. Avoid activities that involve alcohol, as this can cause a setback in treatment.
- Don’t give up hope – it will take a while for treatment to take effect, but anxiety is treatable if your loved one is willing to put in the work.
Seek professional help
In most cases of cases of anxiety disorder, a combination of medication, prescribed by a psychiatrist, and ‘talk’ therapy with a psychologist, is the most successful treatment, according to Pienaar.
“Medication alone often does not get the job done,” she says. “A good response to medication often makes you more amenable to look for the causes of your distress, and to try to change your behaviour. Anxiety disorders can persist for an extended period of time, and the severity may fluctuate, but regular treatment can help a person manage this.”
Joining a support group may also help. Contact Akeso at www.akeso.co.za or SADAG on 011 262 6396 or visit www.sadag.org to find a group in your area.
- Anxiety disorders are ranked as the sixth largest contributor to non-fatal health loss globally.
- It is estimated that 3, 6% of the global population lives with anxiety disorders. As with depression, anxiety disorders are more common among females than males (4.6% compared to 2.6% at the global level).
- Prevalence rates do not vary substantially between age groups, although there is a trend towards lower prevalence among older age groups.
- The total estimated number of people living with anxiety disorders in the world is 264 million. This total for 2015 reflects a 14, 9% increase since 2005, as a result of population growth and ageing.
From Depression and Other Common Mental Disorders, Global Health Estimates, World Health Organization, 2017, http://www.who.int/mental_health/management/depression/prevalence_global_health_estimates/en/
- www.sadag.org, South Africa: A heaven for anxiety disorders
- www.webmd.com, What are Anxiety Disorders, 2005 - 2018.
- www.adaa.org, Understanding the facts, 2010 - 2018
- www.medicinenet.com, Medical definition of panic disorder, 1996 - 2018
- www.health.com, 12 Signs you may have an anxiety disorder, Amanda MacMillan, 27 May 2016
- http://www.who.int/mental_health/management/depression/prevalence_global_health_estimates/en/, Depression and Other Common Mental Disorders, Global Health Estimates, World Health Organization, 2017
- www.sadag.org, Anxiety Treatment and Referral Guide
- www.webmd.com, Anxiety at work, a career busting condition, 2005 – 2018
- www.psychologytoday.com, Why avoidance coping is the most important factor in Anxiety, 2018
- www.verywellmind.com, How your anxiety may affect your relationships, William Meek, 10 Dec 2017
- www.adaa.org, Exercise for stress and anxiety, 2010 – 2018
- www.psychologytoday.com, How to help someone with anxiety, 2018
About the Akeso Group
Akeso is a group of private in-patient psychiatric clinics and is part of the Netcare Group. Akeso provides individual, integrated and family-oriented treatment in specialised in-patient treatment facilities, for a range of psychiatric, psychological and addictive conditions.
Please visit www.akeso.co.za, email [email protected], or contact us on 011 447 0268 for further information. In the event of a psychological crisis, please call 0861 4357 87 for assistance.