Anxiety

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What is the difference between stress and anxiety?

There is some general confusion about the difference between stress and anxiety because of the similarity of some of the symptoms. In the natural stress response, we usually go through normal fight, flight or freeze symptoms, which is the body’s way of saying that it senses danger and it prepares us to be pumped up to attack or defend, to run for it, or to remain still and hide.  With stress, the symptoms are short-lived and tend to subside after the perceived danger has passed, within a few days or weeks at most. However, with anxiety, the symptoms are out of proportion to the situation and difficult to control; reoccurring regularly for months to years; and interfering with a person’s home, school, work and/or social lives. The symptoms of anxiety tend to be worse in periods of stress, but may also occur for no apparent reason.

What are the risk factors for anxiety?

Anxiety, like depression, is caused by a combination of biological, social and environmental factors. There is a link seen in families, for example, from growing up with anxious or avoidant parents. Experiencing a stressful or traumatic event, as well as family dysfunction or development issues in childhood, can increase the risk of developing anxiety. Having another medical or psychiatric problem also increases the risk.

What are the symptoms of anxiety?

With anxiety, like stress, the symptoms are uncomfortable but not dangerous. They are the body’s normal fight, flight or freeze responses that are firing at the wrong times, too frequently or without relief when the stress is gone. The symptoms of anxiety are emotional, physical, mental (involving thought patterns) and behavioural. Many of us will experience some of these symptoms at different times and it is only referred to as an anxiety “disorder” or chronic anxiety when the symptoms reoccur regularly for months to years, often for situations that do not warrant them, interfering with your home, school, work and/or social life.

Emotional symptoms of anxiety are feelings that we tend to associate with being tense or anxious such as fear, dread or worry.

Physical symptoms of anxiety can affect different parts of the body from head to toe. It is important to see your health care provider to rule out any other possible medical problems that may be causing the symptoms. Do not be alarmed if some of the symptoms below seem familiar, because they are also common symptoms in a normal response to stress. However, with anxiety these symptoms are exaggerated and frightening and may even feel life threatening. As long you are sure it is anxiety and not another condition causing the symptoms, they are likely not dangerous.

  • Head: dizziness, unsteady feelings, lightheadedness, or faintness, feelings of unreality or feeling detached from oneself, visual changes (light sensitivity, spots).
  • Mouth, swallowing and digestion: dry mouth or feeling of choking, nausea, stomach distress or gastrointestinal upset, sudden urge to urinate or have a bowel movement.
  • Heart, chest, lungs and breathing: heart racing or pounding, chest pain or discomfort, lungs and breathing: shortness of breath or smothering sensations.
  • Skin: Sweating, trembling or shaking, cold chills, numbing or tingling sensations, blushing or red blotchy skin.
  • Muscles: tension, aches, twitching, weakness or heaviness.

Mental thought patterns related to anxiety are problematic patterns of thinking that can begin to interfere with a person’s life. These thought patterns may include frightening thoughts, irrational beliefs (some may be aware the thoughts are irrational but are unable to stop them), and being consumed by fear or worry and not being able to focus on anything else. Some people experiencing anxiety have found relief with cognitive behavioural therapy (CBT). Part of the work involved with CBT is to teach you to identify these thought patterns and to learn how to replace harmful thoughts with healthier ones. Mindfulness-based cognitive therapy (MBCT) adds a mindfulness component to cognitive therapy, including mindfulness meditation and relaxation techniques to help you become aware of harmful thought patterns.

Coping strategies of anxiety include avoiding or escaping feared experiences or situations (e.g., by sleeping or napping for distraction), clinging to a person or thing that makes us feel safe, needing to be reassured, constantly scanning for signs of danger, compulsive behaviours and mental rituals repeated in an attempt to feel better. Coping strategies can also include self-medicating with drugs, alcohol or food. These strategies may seem okay at first, but are not effective ways of coping with anxiety or stress and can interfere with other aspects of your life.

What types of anxiety are there?

There are more than half a dozen different “anxiety disorders” listed in the official medical compendium of psychiatric disorders. [Note: we intentionally avoid referring to anxiety as a “disorder” because it is a label that tends to stigmatize those diagnosed with it.“Disorder” also medicalizes anxiety and stress, implying it is something chronic and outside the individual’s control]. Many of the so-called “anxiety disorders” share similar characteristics so often someone  diagnosed with one anxiety “disorder” might also be diagnosed with  another. The first similarity is called “anticipatory anxiety” which is anxiety experienced with an upcoming feared situation or experience. The second similarity is a vulnerability to substance use problems and self-medicating with alcohol or drugs to cope with the excruciating feelings of anxiety. This is not surprising, given that many people suffer for years without getting help, and unfortunately, some of the symptoms and coping strategies of anxiety, especially behaviours, can make it very difficult to get help. It is also not surprising that those living with unmanaged anxiety are more likely to experience depression [see depression FAQ].  Some types of “anxiety disorders” that you may have heard of are generalized anxiety, panic, phobias, post-traumatic stress and obsessive-compulsive disorder. Certain medications also cause anxiety, including SSRIs and other antidepressants, and benzodiazepines (tranquilizers and sleeping pills), which are often prescribed to reduce anxiety but may actually increase anxiety especially if they are taken for longer than two weeks.

How can I help myself?

Anxiety is one of the most common mental health problems, so you are not alone. There are support groups and many self-help books dealing with anxiety. The following are some lifestyle changes that can help to minimize anxiety and promote overall well-being. The key is understanding the body’s responses to stress and anxiety so that you can better cope with the symptoms and not overestimate their power over you.

  • Sleep: getting lots of sleep
  • Relaxation techniques: for example, deep breathing, muscle relaxation (tension and release), mindfulness meditation, yoga or tai chi
  • Mindfulness-based cognitive therapy (MBCT)
  • Stress management, including mindfulness-based stress reduction (MBSR)
  • Exercise: exercise such as walking, jogging, swimming or cycling
  • If you are taking medications, check that they are not the cause of your anxiety

Try to avoid caffeine, diet pills, and cold and cough medications as these tend to heighten anxiety. Drugs, alcohol and cigarettes or nicotine may provide temporary relief to anxiety but may make you more anxious or depressed in the long run. This is also true of tranquilizers and sleeping pills as mentioned above. For some people, seeking support to drink less or no alcohol and quit smoking can be helpful.

What kind of help is out there?

Most women diagnosed with anxiety will be prescribed antidepressants (such as SSRIs) and/or started on Cognitive-Behavioural Therapy (CBT), if this is available or affordable. For many, the medication is slow to kick in, has significant side effects (such as short-term increase in anxiety and long-term sexual problems), and it can be difficult to deal with symptoms of anxiety in the meantime. Benzodiazepines are sometimes prescribed as relief in the short-term, until the antidepressants come into effect, but they also have significant side-effects and are difficult to stop taking once on them for longer than two to four weeks [see withdrawal FAQ].  Often the medication is not effective to deal with the symptoms and you may want to try other therapies to fill this gap, including Cognitive-Behavioural Therapy (CBT). Not everyone is well suited for and or motivated to do CBT, and it is important to find a type of therapy (or several) that are a good fit for you.  A number of therapies and lifestyle changes have been shown to have a stronger effect at reducing anxiety than medication and, although they take more effort, they are worth it for your long-term health and well-being. Here is a list of some therapies that have helped many people manage and prevent anxiety:

Where can I get more information?