Anxiety Disorders and how to get help

Welcome to my site! I’m Dr. Elaine Ryan, a psychologist with 20 years of experience in treating anxiety disorders. As someone who has experienced panic disorder personally, I understand what you’re going through and am here to help.

Anxiety is one of the most common mental health problems worldwide, with research undertaken just last year (2022) showing 42% of the adult population of Ireland have a mental health disorder, with 7% of those living with generalised anxiety disorder. The most recent UK survey in 2014 (a new survey is due this year) shows that 6% of the population has anxiety, accounting for over 8 million people.

Many people can recover through self-help, knowledge and psychoeducation, so I have written this detailed guide.

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It is dense in parts, but I firmly believe that if you want to recover from anything, you must understand it first. This guide shall outline anxiety and cite possible reasons for what may cause it before moving on to options that help you recover.

What is anxiety?

Anxiety is a natural emotional response to perceived threats, helping to keep us alert and aware. It serves specific purposes for survival and social interaction:

• Fear: Alerts to danger.
• Disgust: Prevents harmful ingestion.
• Anger: Aids in self-defence.
• Sadness: Signals a need for support.

You can read more on emotions here.

Normal anxiety is a temporary response to stressors like an interview or an exam. It becomes abnormal, or clinical anxiety, when it is excessive, persistent, and interferes with daily life.

A complex interaction between genetic, environmental, and psychological factors causes the disorders.

Anxiety involves various brain regions and neurotransmitters:

• Amygdala: Processes emotional stimuli, particularly fear.
• Prefrontal Cortex: Responsible for decision-making and impulse control.
• Neurotransmitters: Imbalances in serotonin, GABA, norepinephrine, and dopamine can contribute to anxiety.

Imagine the amygdala as your brain’s alarm system. Its job is to spot danger. When something scary happens, it goes off,telling your body to be alert and ready to react. For example, if you see a snake, your amygdala might sound the alarm,making your heart race and your body tense up.

The prefrontal cortex is like your brain’s wise old headmaster. It’s in charge of thinking, planning, and making good decisions. When your amygdala is sounding the alarm, the prefrontal cortex tries to calm things down and figure out what to do. It helps you decide if the snake is really dangerous or if it’s just a harmless garden snake.

Neurotransmitters are like tiny messengers that zip around your brain, carrying information from one brain cell to another.Some important ones for anxiety are:

• Serotonin: This messenger helps you feel calm and settles things down for you
• GABA: This helps to relax your body and turn down the volume in your mind.
• Norepinephrine: This messenger can make you feel alert and focused, but too much will make you anxiety.
• Dopamine: This one is linked to pleasure and reward, ( why you keep eating chocolate! 

When these messengers aren’t working properly, it can lead to feelings of anxiety. It’s like having a noisy alarm system (amygdala), a confused headmaster (prefrontal cortex), and mixed-up messages (neurotransmitters).

Genetics

Genetics play a role in the development of anxiety disorders, although the exact genes involved and how they contribute to the disorder is still not fully understood. Research has shown that the disorders tend to run in families, suggesting a genetic component. When I was writing this article, I remembered a book that I read when I was going through my doctoral training by Sue Gerdhart called Why Loves Matters? In a nutshell, she argues how the love and affection we receive as babies influences how the child’s nervous system develops, for example, if a depressed mum hears her child crying, she might be slow to res[ond whereas a highly anxious parent may jump and bounce the baby vigorously on their need. Hopefully, you can see from my rather crude example that the anxious caregiver may result in a very jumpy baby.

Twin studies have also provided evidence that anxiety disorders are heritable. For example, one study of twins found that the heritability of generalised anxiety disorder (GAD) was around 30-40%, meaning that 30-40% of the variation in GAD symptoms can be attributed to genetic factors.

Studies have also identified specific genes that may be involved in developing anxiety disorders. For example, genes involved in regulating serotonin, a neurotransmitter that plays a role in mood regulation, have been linked to anxiety disorders. Other genes implicated in anxiety disorders include those involved in regulating the stress response, such as the hypothalamic-pituitary-adrenal (HPA) axis.

It’s important to note that genetics alone do not determine whether or not someone will develop an anxiety disorder. Environmental factors, such as exposure to stress or trauma, also play a role in the development of anxiety disorders. Additionally, the interaction between genetic and environmental factors may be complex and multifaceted.

While the role of genetics in anxiety disorders is still being studied, understanding the disorder’s genetic basis may help guide the development of new treatments and therapies. For example, identifying specific genes that contribute to anxiety disorders may lead to the development of new medications that target those genes or their associated pathways.

 Personality traits and anxiety 

Research has shown that certain personality traits are associated with an increased risk of developing anxiety disorders. Here are some examples:

• Neuroticism: This personality trait is characterised by the tendency to experience negative emotions such as anxiety, depression, and worry. People who score high in neuroticism are more likely to develop anxiety disorders, and this relationship has been found in both cross-sectional and longitudinal studies (Lahey, 2009).
• Behavioural inhibition refers to a tendency to be cautious and avoidant in new or uncertain situations. Children who exhibit high levels of behavioural inhibition are more likely to develop anxiety disorders later in life (Caspi et al., 1996).
• Perfectionism is a personality trait characterised by setting high standards for oneself and being overly self-critical when those standards are not met. Perfectionism has been found to be associated with various anxiety disorders, including generalised anxiety disorder and social anxiety disorder (Stoeber & Otto, 2006).

It is important to note that personality traits do not necessarily cause anxiety disorders, but instead they may increase vulnerability to developing anxiety under certain circumstances. Additionally, the relationship between personality traits and anxiety is complex and may involve various interacting factors such as genetics, environment, and life experiences.

Coping styles are how individuals deal with stress and adversity. Research has shown that coping styles can play a role in developing and maintaining anxiety disorders. Here are some examples:

• Avoidant coping: This involves efforts to avoid or suppress anxiety-provoking stimuli or situations. While avoidance may temporarily relieve anxiety, it can also interfere with learning that anxiety is not always dangerous and can exacerbate anxiety symptoms in the long run (Meyer & Carver, 2000). This could be related to the type of attachment style we develop as adults. If you are interested in reading more about attachment, you can start with this article I wrote on attachment styles in adults.
• Emotion-focused coping: Refers to how you manage the emotional distress that can come with anxiety. For example, when emotions are high do you seek out people to distract yourself. While these strategies may help reduce immediate distress, they do not address the underlying causes of anxiety and may not be effective in the long run (Compas et al., 2001).
• Problem-focused coping: This involves efforts to address the underlying causes of anxiety by taking action to change the situation or one’s own behaviour. This might involve jumping onto Google to get information on anxiety, making a plan of action, and engaging in problem-solving activities. Problem-focused coping is generally considered to be more effective than emotion-focused coping or avoidance (Lazarus & Folkman, 1984).

Learning

Learning plays a vital role in the development and maintenance of anxiety disorders. According to learning theory, anxiety disorders can be seen as a result of maladaptive learning. Here are some examples:

• Classical conditioning is a type of learning in which a neutral stimulus becomes associated with a previously meaningful stimulus (such as a feared object or situation) and elicits a similar response. For example, a person who has experienced a panic attack in a crowded elevator may start to feel anxious even when they see an elevator door or hear the sound of an elevator bell. I think this rings true for most people when they first have panic attacks as they are heightened to the threat of them happening again.
• Operant conditioning is a type of learning in which behaviours are reinforced or punished based on their consequences. For example, a person who avoids a feared object or situation (such as flying on an aeroplane) may experience an anxiety reduction and be more likely to avoid the situation.
• Observational learning: This is a type of learning in which individuals learn by observing the behaviours of others. For example, a child who sees their parent react with fear or anxiety to a certain stimulus (such as a spider) may learn to react similarly to that stimulus. This was definitely true in my life and probably for many of you too, where you have been inadvertently taught to be anxious.

Cognitive theory

According to cognitive theory, anxiety occurs when a false assumption is made about a situation, i.e., that it is dangerous, without having direct evidence to prove the threat. If you have worked with a therapist using cognitive behavioural therapy this will already be familiar to you.

For example, someone with social anxiety may believe that an upcoming event is something to be feared. This appraisal of the event leads to a myriad of cognitive errors, resulting in faulty thoughts, such as I cannot do this, I will make a fool of myself, which affects future behaviour; they may avoid the event. If you want to read more about conditions and anxiety, I recommend the following article.

Behavioural learning theory

According to behavioural theories, anxiety is acquired through learning. For example, someone who had been anxious while shopping might pair the experience of shopping with feelings of anxiety; this pairing is inadvertent learning that shopping results in stress.

Life events

Stressful life events can trigger anxiety, disrupting an individual’s sense of safety, security, and control. When faced with a stressful life event, individuals may feel overwhelmed and uncertain about how to cope, which can lead to anxiety.

For example, if an individual experiences a traumatic event such as a car accident or physical assault, they may develop anxiety because the event has shaken their sense of safety and security. They may constantly worry about their safety and become hypervigilant to potential threats, which can cause them to experience anxiety symptoms such as panic attacks, avoidance, and intrusive thoughts.

Similarly, if an individual experiences a major life change such as a job loss or a divorce, they may feel a loss of control and uncertainty about their future, which can trigger anxiety. They may worry about their financial stability, relationships, and ability to adapt to new situations.

It is important to note that not all individuals who experience stressful life events develop anxiety disorders.

Childhood experiences

Studies have shown that traumatic or stressful experiences during childhood, such as abuse, neglect, or exposure to violence, can increase the risk of developing anxiety later in life.

Some examples of childhood experiences that may contribute to anxiety include:

• Parental separation or divorce: Children whose parents separate or divorce may experience significant stress and uncertainty, which can contribute to the development of anxiety.
• Childhood abuse or neglect: Children who experience physical, sexual, or emotional abuse or neglect may develop anxiety as a result of the trauma they have experienced.
• Family conflict: Children who grow up in households with high levels of conflict and tension may experience chronic stress, which can contribute to the development of anxiety.
• Overprotective parenting: Children who are overly sheltered or protected by their parents may not develop the coping skills necessary to manage anxiety and may be more vulnerable to developing anxiety disorders.

Types of anxiety disorders

GAD is characterized by persistent, excessive and unrealistic worry about everyday things. People with GAD may experience physical symptoms such as fatigue, trembling, muscle tension, headache, and nausea. Read more about GAD

Health anxiety is when you are excessively worried about your health. Believing that you may have a serious illness that doctors and tests have missed. Read more on Health Anxiety

Panic Disorder

Panic disorder is characterized by panic attacks, sudden feelings of terror that strike repeatedly and without warning. Physical symptoms include chest pain, heart palpitations, shortness of breath, dizziness, abdominal discomfort, feelings of unreality, and fear of dying. Read more on panic disorder.

Phobias are extreme, disabling and irrational fear of something that poses little or no actual danger; the fear leads to avoidance of objects or situations and can cause people to limit their lives. Read more on phobias.

Social anxiety disorder is fear of social situations in which the person is exposed to unfamiliar people or to possible scrutiny by others. The individual fears that they will act in a way (or show anxiety symptoms) that will be embarrassing and humiliating, often leading to avoidance of social situations and severe distress when participation in social situations cannot be avoided. Read more on social anxiety.

Repeated, intrusive thoughts (obsessions) and repetitive behaviours (compulsions).

Anxiety following exposure to a traumatic event.

Some signs and symptoms are common to emotion, and all anxiety disorders, but some are unique to specific anxiety disorders. The ability to differentiate between them can help signpost whether your anxiety is normal or more indicative of a disorder.

As a rule of thumb, appropriate anxiety is temporary. It is related to a unique event, such as an interview or change in finances, and does not interfere with your ability to live your life.

If your anxiety is interfering with your quality of life. For example, changes in your sleep pattern, changes in your behaviour such as avoiding things, and the feeling does not go away or gets more intense; you should meet with a mental health professional to see if you have an anxiety disorder.

The National Institute of Mental Health explains how everyone can have temporary anxious feelings about life events such as health and finances. But with anxiety disorders, this feeling does not go away, and the symptoms start interfering with your life and ability to get things done.

Emotional Symptoms

Feelings associated with anxiety include fear, worry, and a sense of impending doom.

Physical Symptoms

Bodily manifestations of anxiety can include increased heart rate, sweating, trembling, and dizziness.

Behavioural Symptoms

Anxiety can lead to avoidance of certain situations, changes in sleep patterns, and irritability.

Cognitive Symptoms

Thought patterns related to anxiety often involve excessive worry, difficulty concentrating, and irrational fears.

For a detailed account of anxiety symptoms, please see this post.

Diagnosis

If you suspect you might have an anxiety disorder, it is essential to meet with a licensed mental health professional; a psychologist or psychiatrist can undertake an assessment and tell you not only if you have anxiety, but what type you have.

The clinician will use a tool called the Diagnostic and Statistical Manual of Mental Disorders (DSM). According to the DSM, the criteria for anxiety include the following;

• excessive anxiety and worry most days about many things for at least six months
• difficulty controlling your worry
• the appearance of three of the following six symptoms: restlessness, fatigue, irritability, muscle tension, sleep disturbance, and difficulty concentrating
• symptoms significantly interfering with your life
• symptoms not being caused by the direct psychological effects of medications or medical conditions
• symptoms aren’t due to another mental disorder (e.g. anxiety about oncoming panic attacks with panic disorder, anxiety due to a social condition, etc.)

You might also complete a self-report questionnaire like the Beck Anxiety Inventory (BAI). 

Following the assessment, they can tell you what type of anxiety disorder you have.

Do I need to see a doctor or therapist, and what will they do?

If you follow a stepped-care approach, you may not need treatment by a psychologist, as you can start with self-help. I would have used a stepped care approach when working in the UK, and see that the HSE adopts the same. The idea of this type of working is to do with resources, efficiency and cost, for example, it does not make sense to use all the resources of a mental health team to help someone with mild anxiety, self- help may suffice. The National Institute for Health and Care Excellence (NICE for short) gives guidance on a Stepped Care Approach, which suggests

1. Assessment, education and discussion of treatment options
2. This could be a meeting with your local GP, who diagnoses anxiety or refers you to a psychologist for psychological assessment. Your GP or mental health consultation will explain anxiety to you and recommend treatment options, which may start with self-help.
3. Self Help
4. This can be self-help that you undertake alone or may include psycho-educational group sessions.
5. Psychological intervention CBT or medication
6. If self-help does not work for you, you might be referred for CBT with a psychologist or prescribed medication to help manage your anxiety.
7. Highly specialised treatment
8. This can include psychological intervention, medication and multidisciplinary teams or inpatient care.

Coping with Anxiety

Professional Help: Therapists and Medications

If you are having difficulty managing your anxiety, professional help is recommended. Trained mental health professionals, such as psychologists, psychiatrists, and counsellors, will be able to help you using cognitive-behavioural therapy (CBT) and discuss medication options if necessary. Working with licensed mental health professionals means you can get an accurate diagnosis in terms of the type and severity of your anxiety, ensuring that treatment is both appropriate and effective.

Treatments

Whether you decide to make an appointment to see me for psychological therapy in my clinic in Dublin or meet with another therapist, this final section of the article will give you a good overview of what you need to do and who you should see if you decide to seek professional help with your anxiety.

Anxiety counselling

Your GP may have referred you for anxiety counselling with someone like myself, a psychologist, but there are other types of therapists that can effectively help you with anxiety, for example, CBT therapists. Professional help is crucial for the effective treatment of anxiety, as it provides individuals with access to evidence-based therapies and personalized care. Trained mental health professionals, such as psychologists, psychiatrists, and counsellors, employ a variety of therapeutic approaches, including cognitive-behavioural therapy (CBT), medication, and other interventions tailored to the specific needs of the patient. These professionals are equipped to accurately diagnose the type and severity of anxiety, ensuring that treatment is both appropriate and effective. Additionally, professional support offers a safe space for individuals to discuss their experiences and challenges, fostering a sense of understanding and validation. Regular sessions with a professional can help individuals develop coping strategies, address underlying issues contributing to anxiety, and monitor progress over time, significantly enhancing the likelihood of long-term recovery and improved quality of life.

Lifestyle Factors: Diet, Exercise, and Sleep

• Diet: Balanced nutrition, reduced caffeine and sugar.
• Exercise: Regular physical activity to reduce stress.
• Sleep: Prioritize good sleep hygiene.

Challenging Negative Thoughts: Cognitive Behavioral Techniques

• Identify Negative Thoughts: Recognize unhelpful thoughts.
• Challenge Thoughts: Question the validity of these thoughts.
• Replace with Positive Thoughts: Develop healthier thinking patterns.

How to deal with anxiety right now

If you are feeling anxious right in this very moment, the remainder of this article includes videos I made to help you with guided relaxation. They are only short-term strategies and do not replace meeting with a mental health professional for assessment and treatment.

Short-term ways to manage anxiety.

If you are feeling anxious right now, the following brief videos will help you manage your current anxiety.

Controlled breathing

The following video will help you to control your breathing.

7-11 breathing

Breathing

• It will allow your breathing to settle and calm your nervous system
• It will stop you from focusing on everything else that may increase or contribute to your anxiety.

“Dr. Elaine Ryan is a Dublin-based psychologist with a proven track record in treating anxiety disorders. With over 20 years of experience, she offers compassionate and effective therapy to help individuals overcome their challenges. To schedule an appointment or learn more about Dr. Ryan’s services, please feel free to contact the clinic.”

Sources

References

1. Ekman P. Basic Emotions. Handbook of Cognition and Emotion. 2005:45-60. doi:10.1002/0470013494.ch3
2. Hockenbury, D. and Hockenbury, S.E. (2007). Discovering Psychology.New York: Worth Publishers.
3. Vora, E. (2022) The anatomy of anxiety.  Orion Spring