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Anxiety

What Is It?

Anxiety is a normal part of life. We all feel anxious at times. Anxiety helps to protect us. Think of a driver slamming on the brakes when someone cuts them off in traffic. This reaction keeps the driver safe. This is anxiety. Anxiety becomes problematic when the worrying does not shut off and it starts interfering with the person’s life.  Anxiety is like a tape recorder which plays on repeat in a person’s head. Anxiety disorders are characterized by extreme fear, worry, and behavioural changes as a response to the fear. Anxiety is the constant worry of “what if?”. “What if this happens?” … “What if that happens?”. This feeling of “what if” is in relation to a future event or threat, whereas fear is from a current threat, whether it is real or perceived.

There are several common anxiety disorders

Generalized Anxiety Disorder

Generalized anxiety disorder is constant worrying. The worrying/anxiety is difficult to control. The person may have anxiety about daily tasks. Compared to others, people with generalized anxiety disorder (GAD) worry more often.

Their worries could include, but not be limited to:

  • Being on time
  • School
  • Small decisions
  • Relationships
  • Personal health
  • The health of someone they care about
  • The future
  • The state of the world

What could feel like a little thing to others might send a person with GAD spiraling into a state of worry. Their brain might start “chaining” worries. This means they could start with one worry which leads to the next on to the next.

 

For example, there is a test on Monday. A person with anxiety might start thinking:

“What if I fail this test?”

“What if my parents get mad and start fighting because I failed my test?”

“What if my parents get a divorce?”

“What if one of my parents has to move out and I never see them again?

Panic Disorders

Panic disorder is characterized by repeated panic attacks. Panic attacks are one of those things people will sometimes use to describe worrying, but that is not quite it. Panic attacks are more than feeling worried or apprehensive. They can be triggered by certain things or seemingly come out of nowhere. If someone has one panic attack that does not mean they have panic disorders. It becomes problematic when the individual is worried or anxious about having more panic attacks.

Phobias

Phobias are fear about a certain thing (situation, event, object, animal, etc.). The level of fear is overwhelming and amplified compared to the actual level of danger. It is more severe and long lasting than feeling nervous or anxious about something. They can affect how a person functions in their daily living.

The most common phobias are to:

  • Situations
  • Nature
  • Animals
  • Blood
  • Others

Social Anxiety

Social anxiety, also known as social phobia, is when a person experiences anxiety or fear in relation to social situations. The fear is around certain or all social situations (talking in class, dating, meeting new people, doing things in front of people, etc.). The anxiety feels uncontrollable. The worry can last days or weeks before the event happens. They might replay interactions or incidents repeatedly in their head. The person might also feel physical symptoms during social interactions.

A person with social anxiety could be triggered by the following:

  • Meeting new people
  • Attending social gatherings
  • Going to work, school, grocery store, etc.
  • Eating or drinking in front of people
  • Starting conversations
  • Eye contact
  • Dating
  • Returning items to a store
  • Asking for help
  • Answering a question in class
  • Using a public restroom

Separation Anxiety Disorder

Feeling anxious about being separated from loved ones is a natural reaction in young children (between 18 months and 3 years of age). If the anxiety persists and gets worse, it might be separation anxiety disorder. The anxiety is usually about being separated from a parent or caregiver. Separation anxiety disorder is not only for children. It can impact teenagers and adults. This can cause problems in going to work, leaving the house, going to school, etc.

Obsessive-Compulsive Disorder

Obsessive-compulsive disorder (OCD) is an anxiety disorder which is characterized by a pattern of distressing thoughts and fears. These obsessions lead to compulsions which are repetitive behaviours. This can cause great distress and often interferes with daily tasks and activities.

 

There is a common belief that OCD is simply being neat and tidy. That is not the case. While a person with OCD might make things orderly, it is not just because they like it that way. OCD makes the person feel very stressed or as if something bad will happen if things are not orderly. If the person tries to ignore the obsessions and compulsions, they become worse. The anxiety becomes more severe.

 

Obsessions could have the following themes:

  • Unwanted thoughts
  • Needing things to be neat and orderly
  • Difficulty with the unknown
  • Fear of dirt, germs, or contamination
  • Violent thoughts about losing control and hurting self or others

Compulsions could have the following themes:

  • Orderliness
  • Checking things (locks, taps, oven, etc.)
  • Strict routine or schedule
  • Cleaning and washing
  • Counting
  • Need for reassurance

Myths / Facts

FACT – Anxiety disorders are real. They are not just something a person can turn off.

If someone has not experienced anxiety, they often think it is something someone can just shut off. That is the difficult thing about mental health issues. It is not something someone can see so they assume it is not real or serious. That is not the case. Anxiety disorders are real and interfere with a person’s ability to function during the day. It can also cause the person to overreact when something triggers the person. It can be hard for the person to explain their reactions or anxiety. No one has a switch to turn off their emotions. It is the same with anxiety. A person with an anxiety disorder cannot just decide to not have an anxiety disorder anymore. Their experience is valid.

FACT – Anxiety disorders have similar symptoms, but they are not the same.

While different anxiety disorders have similar feelings, they are not all the same. Each anxiety disorder is affected by different things. For example, someone with generalized anxiety disorder is not triggered by anything specific whereas social anxiety is triggered by social situations. Anxiety disorders are different for everyone. Two people with the same disorder could have different experiences, symptoms, and severity.

FACT – Children can be impacted by anxiety, too. Anxiety disorders can impact anyone of any age.

This is a common misunderstanding. People often think children and youth cannot struggle emotionally, but that is not true. It can be tricky because children who have anxiety are often quiet and well-behaved, so people do not notice. The child does not want to stand out. There are some kids who act out when they are struggling with anxiety which can also mean they do not get the help they need and deserve.

It is important to connect with help when struggling with anxiety. If anxiety goes untreated, it can become worse, and the person may miss out on very valuable opportunities.

FACT – There are many types of treatments that can help treat anxiety.

There are many different types of treatments for anxiety disorders. The two main types of treatment are therapy and medication. Therapy can help the person learn skills to deal with their symptoms. There are also different types of medications that help with the symptoms of anxiety. It all depends on the type of anxiety disorder the person has as well as other factors.

There are also other things that can be used to help manage the symptoms of anxiety. Developing a healthy lifestyle can help support mental health.

More tips for managing anxiety:

  • Eat well and be active. To be healthy, we must take care of our bodies too. Exercise helps to reduce stress. Practice moderation.
  • Relaxation techniques
  • Avoid smoking, caffeine, alcohol, and recreational drugs
  • Get enough sleep. Sleep helps with regulating emotions. Lack of sleep makes us more vulnerable and sensitive to stress.

See below for more wellness tips.

FACT – Everyone feels anxious from time to time, but not everyone has an anxiety disorder.

Anxiety is a part of life. The nervousness or anxious feelings are experienced by everyone. The cause of the anxious feelings is usually the result of a change or challenge in the environment, whether good or bad. This makes it tricky when talking about anxiety, but there is a difference between anxiety and anxiety disorders. Everyone has anxiety (feels anxious) periodically, but not everyone has an anxiety disorder. Anxiety disorders start to interfere with life and wellness.

FACT – Healthy coping skills help to support positive mental health, but it will not cure anxiety disorders.

A healthy lifestyle can help deal with the symptoms of anxiety. Exercising, sleeping, eating well, relaxation techniques, and hobbies can help to reduce stress and promote mental wellness. This does not cure anxiety. While eating well and cutting caffeine can help anxiety, it will not make anxiety disappear. It is about learning how to deal with the symptoms, finding a treatment that works for the individual, and asking for help when needed.

FACT – Social anxiety and shyness are different.

There is a common belief that social anxiety is someone being shy. That is not the case. Shyness is not a disorder. It is a personality trait. There are some people who are shy and have social anxiety, but that is not the case for everyone. Not everyone who is shy has social anxiety, and not everyone who has social anxiety is shy. There are people with social anxiety disorder who like to be around many people and the center of attention once they overcome their social anxiety. Many people who are shy do not view their shyness poorly. People with social anxiety disorder find it upsetting.

Causes of Anxiety

Like any mental health concern, the cause of anxiety is not straightforward. Everyone has a different story. The causes are not widely known or understood, but there are several risk factors. Some people are more likely to develop anxiety than others.

Some risk factors of developing anxiety:

  • Genetics
  • Trauma
  • Excessive stress
  • Different personality types
  • Substance use/abuse
  • Medical Problems
  • Medications
  • Other mental health disorders


As with any mental health disorder, it is important to remember it is not the person’s fault. It is not a personality or character flaw.

What Does it Look Like?

Generalized Anxiety Disorder

Symptoms could include:

  • Restlessness
  • Easily tired
  • Mind blanking
  • Difficulty concentrating
  • Tense muscles
  • Moodiness
  • Issues with sleep
  • Perfectionism
  • Hates or strongly dislikes the unknown, so they are constantly looking things up, seeking reassurance, etc.
  • Avoids making decisions
  • Cancelling plans
  • Physical symptoms (headache, stomachache, tiredness, difficulty breathing, muscle tension, etc.)
  • Feeling overwhelmed or out of control
  • Overgeneralizations
  • All or nothing thinking

Panic Disorders

Panic attacks feel like:

  • Heart pounding
  • Shaking
  • Hyperventilating or cannot catch breath
  • Feeling restricted from clothes/room
  • Chest pain (some confuse it with a heart attack)
  • Dizziness
  • Light-headedness
  • Nausea
  • Numbness
  • Intense fear or dread
  • Crying
  • Loss of control
  • Feeling out of control or claustrophobic


Panic disorder can also include:

  • Avoiding places where panic attacks have occurred
  • Avoiding crowded spaces and strenuous activity
  • Fear about having another panic attack

Phobias

Symptoms could include:

  • Immediate reaction to the object or situation
  • Fear is consistent (the person gets scared every time they are exposed to it)
  • Bigger reaction than the actual threat level
  • Actively avoid the phobia
  • Awareness their fear is not reasonable, but they feel like they cannot control it
  • Amplified fear as the situation or object gets closer to them
  • Physical symptoms (increased heart rate, hard time breathing, sweating, etc.)
  • Fainting or light-headedness
  • Crying or tantrums

Social Anxiety

Symptoms could include:

  • Negative thoughts about self and how others will react to them
  • Constantly thinking about how others are perceiving them/how they are acting in social situations
  • Physical symptoms of anxiety (blushing, sweating, shaking, racing heart, dizziness, shortness of breath, stomachache, nausea, etc.)
  • Worried other people will notice physical symptoms
  • Avoid social situations
  • Avoid drawing attention to themselves in social situations
  • Worry other people do not like them or that they are being judged
  • Difficulty in social situations

Obsessive-Compulsive Disorder

Symptoms could include:

Obsessions

  • Not wanting to touch items other people have touched
  • Doubts and second-guessing if something has been done properly (locking the door, turning off appliances, etc.)
  • Extreme discomfort when things are not orderly or lined up
  • Thoughts or images of driving a car through a group of people
  • Thoughts of shouting inappropriate things in public or behaving inappropriately
  • Upsetting sexual images
  • Avoidance of triggers (touching others, etc.)

Compulsions

  • Arranging things a certain way
  • Repeating words, prayer, or phrases silently
  • Counting in a certain pattern
  • Checking things repeatedly to make sure they are off or locked
  • Washing hands until raw

 

These obsessions and compulsions are paired with anxiety or dread; it is not just personal preference.

Separation Anxiety Disorder

Symptoms could include:

  • Fear something bad will happen to loved ones while separated
  • Fear of something happening to self
  • Fear of something unexpected happening
  • Fear of being left or forgotten about
  • Physical symptoms of anxiety (racing heart, sweating, hot flashes, blushing, headache, stomachache, digestive issues, frequent urination, shortness of breath, etc.)
  • Feelings of fear, shame, anxiety, anger, helplessness, and embarrassment
  • Avoiding leaving the house
  • Disliking alone time
  • Being sick to avoid school, work, or activities
  • Not wanting to go somewhere without a loved one
  • Crying when being left

What to Do if You are Struggling With Anxiety?

Coping with anxiety can be very challenging, especially when you are doing it alone. It can feel overwhelming. So, what can you do if you are struggling with anxiety?

  1. Remember, no one feels 100% all the time. It is okay not to be okay. It is about seeking help when you need it.
  2. Tell someone you trust. Find someone you trust who will help you connect with professional help. You deserve to feel better and get help!
  3. Practice self-care. Make healthy choices for your mental health and practice positive coping skills. Find people who support you.
  4. Believe in yourself. You’ve got this! You deserve to be happy, and it is possible.

How Can You Help?

When a friend or loved one tells you they are struggling, it can be tricky to know what to say. We want our loved ones to be okay, but there will be times when they are not doing well. It can be hard to know what to say. We often want to solve their problems and give them advice, but that is not your job. Your job is to connect your friend with a helping professional.

The following are some guidelines of what to do if someone tells you they are struggling. This is not to counsel the person. This is to get the person connected with a counsellor, doctor, or another professional. Please remember the conversation will not be linear like on the page. These are guidelines of some things to consider:

  1. Take a deep breath and stay calm. The person is telling you something scary and personal to them. This is terrifying for both of you. Take a deep breath. When we care about someone and they tell us about their struggles, we sometimes react with what seems like anger. This is often an outward display of fear which comes across as anger. This can make it difficult for the person to open up to you. Take that moment to gather yourself and take a deep breath. Remember this is about them and their experience.
  2. Listen to the person. Give the person the time and consideration you would like if you were struggling. Be the person you would like listening to you in this situation. Give them your full attention. They deserve it. It will also help you know what the person is trying to tell you. While you are listening, be understanding and compassionate. Give them the space to talk.
    1. Do not judge your friend. What they are coping with might not seem like a big deal to you, but it is to them. Therefore, it is valid.
    2. Do not interrupt your friend. Being interrupted is very frustrating. It can make the person feel like they are not being heard.
    3. Put your phone down! Have you ever talked to someone who is on their phone, and they don’t hear a word you say? It can be very frustrating. Treat your friend with the respect they deserve.
    4. Be the best friend you can be and the person you would like if you were in that situation.
  3. Help the person think of who they can tell and support them in seeking help. Your loved one needs to get help. This is not something you can deal with without professional help. Help the person think of someone they trust/who they would like to talk to about their struggles. If they feel like they cannot think of anyone to talk to, help them connect with resources, like a counselor, medical doctor, psychologist, or mental health professional. You can also offer your loved one some helplines they can call when they are struggling too. If you are comfortable, you can also offer to go with your loved one to get help. If your loved one does not connect with the first person they see, try someone else. Not every counselor is for every person. Just keep trying. There is someone out there your loved one will connect with!
  4. Do not keep it a secret. If your loved one asks you to keep it a secret, you cannot keep it a secret. There are three instances where you break someone’s confidence:
    • They are going to harm themself.
    • They are going to harm someone else.
    • They are being harmed by someone.
    • You can tell someone that, based on what they have said, you have to tell someone to get them help.
  5. Get help for you, too. Talking about mental health concerns is challenging. Talk to someone about it to help cope with the stress of the situation. Practice self-care. Do something you enjoy. For self-care ideas, visit the self-care section here.

 

Please remember – if someone you know dies by suicide, it is not your fault. It is a choice they made. Please get help for yourself. It is important you talk to someone and get help for yourself.

How Do You Ask Someone About Their Mental Health?

If you have a feeling something is going on, have a conversation with the person if you feel comfortable talking to them. (If you do not feel comfortable, that is okay. You just need to tell someone who will have the conversation with them and connect them with help).

The following are some guidelines of what to do if you suspect someone is suicidal or not doing well. This is not to counsel the person. This is to get the person connected with a counselor, doctor, or another professional. Please remember the conversation will not be linear like on the page. These are guidelines of some things to consider.

Before You Have the Conversation

  • Make sure you have time for it
  • You are in a place the person will feel comfortable to talk to you
  • Approach the situation with compassion
  • Make sure you are willing to listen
  • Remember you can initiate the conversation and let them know you are there, but it may take some time before they talk to you.
  1. Take notice. If you feel like something is going on with someone, there likely is something. Trust that gut instinct.
  2. Talk to them. Open the conversation in a nonjudgemental and compassionate way. Start off by stating a change you have noticed. Use “I” statements so it does not feel like you are accusing them.
    • Example: “Hey, I have noticed you have been cancelling plans lately. How are you doing?” or “I heard you putting yourself down in class. What’s been going on?”
  3.     Listen. Listen to hear and understand. If you do not understand something they are saying, paraphrase and ask them to clarify. Listening means putting down your phone and giving them your undivided attention. Let the person talk. Do not feel the need to fill the silence. Allow them the space they need. Sometimes, we want to interject our opinion, but this is about the person, not your opinions. While you listen, approach the situation with nonjudgement and compassion.
  4. Connect the person with help. If their level of risk is high and they cannot keep themselves safe, connect them with emergency services. If they are not a danger to themselves, they still need help. Connect the person with a counsellor, agency, or person they can talk to about what is going on in their life.

 

DO NOT keep it a secret. You must tell someone so the person gets help. You must connect the person with a mental health professional.

Follow-up Support for Someone with Anxiety

  • Be understanding
    • There are times when the person might cancel plans, are not feeling well, or need a break.
  • Support your friend in making healthy choices
    • Your friend might have to make some changes to support their mental health. Support them in making healthy choices.
  • Give your friend a choice of helplines to call when they need someone to talk to
  • Have fun with your friend!
  • Understand some of your friend’s reactions could be due to their anxiety
  • Practice boundaries

Things to Avoid

  • Gossiping about your friend’s mental health
  • Telling your friend to quit worrying
  • Telling them how to feel
  • Acting as your friend’s counselor
  • Telling your friend what to do
  • Making your friend’s mental health struggles about you
  • Toxic positivity
    • Being optimistic practicing is wonderful and can help improve mood and mental health, but the sunshine outlook can sometimes take a dark turn. Toxic positivity is reframing the situation (even tragic ones) in a positive light (Johnson, 2021). This is the “at least…” or “it could be worse…” This may sound like a good thing, but this comes at the expense of any other emotions. It is okay to feel upset about something. It is okay to not be okay, but toxic positivity suppresses any of those emotions. Positive outlooks can be a wonderful thing, but not when it comes at the expense of coping with emotions and difficult situations.

Tips for Wellness

There are many things you can do to support your wellness. The following activities can help you support your mental health and manage anxiety symptoms. It is also important to seek professional help.

 

  • Adopt a healthy lifestyle
    • Eating well, being active, and getting enough sleep is an important part of promoting mental health
    • Eating well helps your brain and body have energy and the capacity to function
    • Being physically active is a wonderful way to reduce stress by increasing feel good hormones in the body
    • Sleep is an important part of emotion regulation and the ability to problem solve. Think of a time when you have not had enough sleep and you have a hard time thinking clearly or your emotions have felt like a rollercoaster. Sleep is very important your overall health.
  • Avoid caffeine alcohol, and other illicit drugs.
    • While it may feel like these things help you to relax in the moment, they increase the feelings of anxiety and paranoia, with some increasing anxiety immediately and others causing the increase over time (Anxiety and Depression Association of America, n.d.).
  • Practice relaxation techniques, like deep breathing, mindfulness, or meditation
  • Have fun
  • Connect with others
  • Ask for support
  • Get to know your anxiety and what triggers it
  • Find what works for you

Further Resources

Anxiety (apa.org)

Anxiety disorders – Diagnosis and treatment – Mayo Clinic

Anxiety disorders – Symptoms and causes – Mayo Clinic

Anxiety Disorders (for Teens) – Nemours Kidshealth

Anxiety Happens: It’s Not a Choice | Psychology Today Canada

Anxiety in Children – Anxiety Canada

Anxiety: Causes, Symptoms, Treatment, and More (healthline.com)

Diagnostic criteria for anxiety disorders set out in DSM-IV and ICD-10 classification systems – Clinical effectiveness of interventions for treatment-resistant anxiety in older people: a systematic review – NCBI Bookshelf (nih.gov)

Do I have anxiety or worry: What’s the difference? – Harvard Health

Emotion, emotion regulation and sleep: An intimate relationship (nih.gov)

Generalized Anxiety Disorder – Anxiety Canada

Mood and anxiety disorders in Canada – Canada.ca

NIMH » Anxiety Disorders (nih.gov)

NIMH » Social Anxiety Disorder: More Than Just Shyness (nih.gov)

Obsessive-compulsive disorder (OCD) – Symptoms and causes – Mayo Clinic

Panic Disorder | CAMH

Separation Anxiety – Anxiety Canada

Separation anxiety disorder – Symptoms and causes – Mayo Clinic

Separation Anxiety Disorder in Children (stanfordchildrens.org)

Social Anxiety Disorder – Anxiety Canada

Social anxiety disorder (social phobia) – Symptoms and causes – Mayo Clinic

Specific phobias – Symptoms and causes – Mayo Clinic

Tips to Manage Anxiety and Stress | Anxiety and Depression Association of America, ADAA

UPMC HealthBeat: Myths and Facts About Anxiety

If you would like to speak to someone about mental health issues, the Alberta Health Services Mental Health Help Line is available 24/7, offering information and referrals on any aspect of mental health.

Call toll-free: 1-877-303-2642

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