UNDERSTANDING ANXIETY

ANXIETY DISORDERS AT A GLANCE

SOCIAL ANXIETY DISORDER (SAD)

  • Intense and persistent fear of being watched and judged by others.
  • Everyday interactions cause significant anxiety, self-consciousness and embarrassment because you fear being scrutinized or judged negatively by others.
  • The anxiety/fear leads to avoidance of social situations
  • Tendency to analyze your performance and find flaws in your interactions after a social situation
  • Expect the worst possible consequences from a negative experience during a social situation
  • Experience anxiety in anticipation of a feared social activity or event.
  • Generalized social anxiety denotes a pervasive form of social anxiety with fear and avoidance of a wide range of social situations. It is also the most disabling form of the illness.
  • Studies do not report cases of childhood maltreatment in social anxiety, but they consistently show that behavioral inhibition, a heritable temperamental trait, is commonly an antecedent to the development of social anxiety.

GENERALIZED ANXIETY DISORDER (GAD)

  • Excessive worry and fear about anything and everything, including your own thoughts.
  • Inability to relax or feel comfortable with oneself.
  • Unable to control the anxiety.
  • Difficulties with sleep/insomnia.
  • Loss or no appetite, usually accompanied by weight loss at the onset of GAD.
  • Feeling tense, breathing fast/ hyperventilating, fatigue, digestive problems and other physical symptoms linked to hyper arousal.
  • Preoccupation with one’s thoughts.

OBSESSIVE-COMPULSIVE DISORDER (OCD)

  • Uncontrollable and repetitive thoughts/ideas/sensations (obsessions) that forces you to act upon them (compulsion).
  • Typical obsessions: Fear of getting contaminated by people or the environment; Disturbing sexual thoughts or images; Fear of blurting out obscenities or insults; Extreme concern with order, symmetry, or precision; Recurrent intrusive thoughts of sounds, images, words, or numbers; AND Fear of losing or discarding something important.
  • Typical compulsions: Excessive or ritualized hand washing, showering, brushing teeth, or toileting; Repeated cleaning of household objects; Ordering or arranging things in a particular way; Repeatedly checking locks, switches, or appliances; Constantly seeking approval or reassurance; AND Repeated counting to a certain number
  • Compulsions are only meant to alleviate the worries and fear triggered by the obsessions.
  • The severity of symptoms is usually gradual.

AGORAPHOBIA

  • Excessive fear/ anxiety related to being in a public or crowded place, from which a potential escape is difficult, or help may not be readily available.
  • The anxiety is usually triggered by the fear that a panic attack or panic-like symptoms may occur in those situations.
  • The person usually avoids being in those situations or endure them with extreme anxiety. Typically, a person with agoraphobia tend to be homebound.
  • Often the person with agoraphobia experiences social isolation and depression.
  • It usually develops after a stressful even or the experience of a panic attack

POST-TRAUMATIC STRESS DISORDER (PTSD)

  • Intense anxiety following the experience of witnessing of a terrifying event(s) or trauma.
  • Common symptoms of PTSD:vivid flashbacks (feeling like the trauma is happening right now); intrusive thoughts or images; and nightmares.
  • Intense distress at real or symbolic reminders of the trauma.
  • Physical sensations such as pain, sweating, nausea or trembling.
  • The person typically relives the trauma through out-of-the blue flashbacks and nightmares.
  • Avoid thinking about or feeling emotions about the trauma, which can interfere with your emotional recovery and healing.
  • The trauma in itself can be insignificant to an outsider, because what really matters is how it has affected the person, and thus the trauma is really subjective.

PANIC DISORDER (PD)

  • Unexpected and repeated episodes of intense fear accompanied by physical symptoms that may include chest pain, heart palpitations, shortness of breath, dizziness, or abdominal distress. (panic attacks).
  • Not everyone who experiences a panic attack will develop PD.
  • Panic attacks can occur as frequently as several times a day or as rarely as a few times a year.
  • Fearing/worrying about another panic attack, the person may make significant changes in their life, including avoiding certain situations.
  • Physical symptoms during a panic attack, such as: pounding or racing heart, sweating, chills, trembling, difficulty breathing, weakness or dizziness, tingly or numb hands, chest pain, and stomach pain or nausea

GLOSSARY FOR ANXIETY

I – PERSONAL EXPERIENCE WITH ANXIETY

Excessive worry:

A hallmark symptom of anxiety is excessive and persistent worry about a wide range of everyday events or activities. This worry can feel difficult to control and can interfere with daily life.

Physical symptoms:

Anxiety can cause a variety of physical symptoms, including sweating, trembling, rapid heartbeat, shortness of breath, and gastrointestinal problems like nausea and diarrhea.

Restlessness:

People with anxiety may feel restless or on edge, and may have difficulty sitting still or relaxing.

Fatigue:

Anxiety can be exhausting, and people with anxiety may feel tired or fatigued even if they haven’t done anything physically strenuous.

Irritability:

Anxiety can make people feel on edge or irritable, and they may be more easily annoyed or frustrated.

Sleep problems:

Anxiety can interfere with sleep, causing difficulty falling asleep and/or staying asleep. Waking up early in the morning is another sleep problem common in anxiety.

Avoidance behaviors:

Some people with anxiety may avoid situations or activities that trigger their anxiety, which can lead to a sense of isolation and may limit their ability to participate in everyday life.

II – MEDICAL TERMINOLOGY

Panic attacks:

A panic attack is a sudden onset of intense fear or discomfort, accompanied by physical symptoms such as chest pain, shortness of breath, and dizziness. Panic attacks can be frightening and debilitating, and can occur without warning.

Intrusive thoughts:

Some people with anxiety experience intrusive, unwanted thoughts or images that can be distressing and difficult to control.

Phobias:

A phobia is an intense and irrational fear of a specific object or situation. People with phobias may go to great lengths to avoid the feared object or situation, which can limit their daily life.

Social anxiety:

Social anxiety is a type of anxiety characterized by a fear of being judged, evaluated, or scrutinized by others. People with social anxiety may avoid social situations or experience intense anxiety when in social situations.

Generalized anxiety disorder (GAD):

GAD is a chronic form of anxiety characterized by excessive worry and anxiety about a wide range of everyday events or activities. People with GAD may worry about things that are unlikely to happen or that they have little control over.

Obsessive-compulsive disorder (OCD):

OCD is a type of anxiety disorder characterized by persistent, intrusive thoughts (obsessions) that lead to repetitive behaviors (compulsions). People with OCD may engage in repetitive behaviors to reduce their anxiety, but these behaviors can be time-consuming and interfere with daily life.

Post-traumatic stress disorder (PTSD):

PTSD can develop after experiencing or witnessing a traumatic event. People with PTSD may experience flashbacks, nightmares, and avoidance behavior related to the traumatic event.

Treatment:

Treatment for anxiety can include therapy, medication, and self-help strategies. Cognitive-behavioral therapy (CBT) is a common form of therapy for anxiety that helps people identify and change negative thought patterns and behaviors. Medications like antidepressants and anti-anxiety medications can also be effective in treating anxiety. Self-help strategies like exercise, relaxation techniques, healthy diets, and stress management can also be very helpful in managing and overcoming anxiety symptoms.

THREE SELF-REPORT QUESTIONNAIRES COMMONLY USED TO EVALUATE AND ASSESS ANXIETY SYMPTOMS

In a therapeutic setting, symptoms of anxiety are assessed and measured on a scale, as one of many tools used to screen for the presence and severity of anxiety.

Typically, a scale is a questionnaire that is administered by a clinician in some cases or by the self in others. Each one lists a series of particular symptoms on a temporal continuum to help assess severity. Those lists focus on general symptoms of anxiety, and others still are designed to help identify and characterize a specific anxiety disorder (e.g., social anxiety).

We now invite you to a review of three well-known anxiety screening tools to help you better understand how you would be evaluated in a therapeutic setting and also to empower you to take charge of your psychological health.

THE STATE TRAIT ANXIETY INVENTORY (STAI)

Purpose: Measures the presence and severity of current symptoms of anxiety and a generalized propensity to be anxious.

Description: 2 subscales: The State Anxiety Scale (S-Anxiety) evaluates the current state of anxiety, asking how respondents feel “right now.” The Trait Anxiety Scale (T-Anxiety) evaluates relatively stable aspects of “anxiety proneness,” including general states of calmness, confidence, and security.

Format: 40 questions total, 20 for each subscale.

Administration: This is a self-report questionnaire

Score interpretation: Scores for each subtest range from 20 to 80 with high scores indicating greater anxiety. The cut-off point for “clinical” state anxiety (the S-Anxiety scale) is a subject of controversy as some research indicates that 39–40 is high enough while others have suggested 54–55 for older adults.

Sample questions:

S- anxiety scale:

“I feel calm” … NOT AT ALL; SOMEWHAT; MODERATELY SO; VERY MUCH SO

T- anxiety scale:

“ I worry too much over something that really doesn’t matter”……… ALMOST NEVER; SOMETIMES; OFTEN; ALMOST ALWAYS.

 

References:

Spielberger, C. D., Gorsuch, R. L., Lushene, R., Vagg, P. R., & Jacobs, G. A. (1983). Manual for the State-Trait Anxiety Inventory. Palo Alto, CA: Consulting Psychologists Press.

BECK ANXIETY INVENTORY (BAI)

Purpose: This measure focuses of on somatic symptoms of anxiety (i.e., physical symptoms).

Format: 21 questions total

Administration: This is a self-report questionnaire

Score interpretation: The total score is calculated by finding the sum of the 21 items. It ranged from 0–63. The following guidelines are recommended for the interpretation of scores: 0–21, low or no anxiety; 22–35, mild to moderate anxiety; and 36 and above, potentially concerning levels of anxiety.

Sample questions:

“Unable to relax”: ………NOT AT ALL; MILDLY BUT IT DIDN’TBOTHER ME MUCH; MODERATELY- IT WASN’T PLEASANT AT TIMES; SEVERLY – IT BOTHERED ME A LOT

“Fear of worst happening”: ………NOT AT ALL; MILDLY BUT IT DIDN’TBOTHER ME MUCH; MODERATELY- IT WASN’T PLEASANT AT TIMES; SEVERLY – IT BOTHERED ME A LOT

References:

Beck, A. T., Epstein, N., Brown, G., Steer, R. A. (1988). An
inventory for measuring clinical anxiety: Psychometric
properties. Journal of Consulting and Clinical Psychology,
56, 893-897.

.

HOSPITAL ANXIETY AND DEPRESSION SCALE – ANXIETY  (HADS – A)

Purpose: This scale measures generalized symptoms of anxiety and fear. It was specifically created to assess anxiety and depression in medically ill patients.

Description: Two subscales: one focusing on anxiety HADS-A and the other assessing depression HADS-D

Format: 7 questions total

Administration: This is a self-report questionnaire

Score interpretation: Summing the score for each question will yield a total score, keeping in mind that a few items are scored in reverse. The total score for the HADS-A can range from 0 to 21. The following guidelines are recommended for the interpretation of scores: 0–7 for normal or no anxiety, 8–10 for low to mild anxiety, 11–21 for moderate anxiety to severe anxiety.

Sample questions:

I feel tense or ‘wound up’….. MOST OF THE TIME; A LOT OF THE TIME; FROM TIME TO TIME, OCCASIONALLY; NOT AT ALL.

“I get a sort of frightened feeling like’butterflies’ in the stomach:”…….. NOT AT ALL; OCCASIONALLY; QUITE OFTEN; VERY OFTEN.

 

References:

Zigmond AS, Snaith RP. The hospital anxiety and depression scale. Acta Psychiatr Scand. 1983;67:361–370. doi: 10.1111/j.1600-0447.1983.tb09716.