By Vashni Benjamin
According to a 2016 study by “Our World in Data”, around 275 million of the world’s population suffers from anxiety disorders.
While a certain level of anxiety is quite common in the human walk of life, there is also the possibility of it developing into a disorder that may affect our day-to-day activities. While the topic of anxiety has evolved into more of a pop culture term than a medical condition as of late, untreated anxiety disorders can lead to serious consequences such as depression, suicidal thoughts, and harmful physical conditions.
Anxiety disorders can be triggered by work stress, exams, or even the change in weather and therefore, it won’t be a surprise if the recent terror attacks that shook the country may have planted seeds of anxiety in our minds as well. In order to help us understand anxiety and determine the point at which it becomes an issue of concern, we spoke to clinical psychologist Shanelle De Almeida.
Anxiety is one of the most common and treatable forms of mental illness, which many people don’t take seriously. Should we be taking it seriously, and if so, why?
Very often, people don’t know what anxiety really means, it is more of a “pop culture” term now, rather than a clinical one.
There are many levels and types of anxiety. If we look at Generalised Anxiety Disorder, it can be quite serious if not addressed within the first six months of onset. If it becomes chronic, it can lead to insomnia, loss of appetite, panic attacks, muscle tension, long-term heart problems, and eventually lead to other disorders such as clinical depression and obsessive compulsive Disorder (OCD).
However, if they are usually only sporadic panic attacks, a simple intervention based on self-care can help alleviate the problem effectively.
The Anxiety and Depression Association of America (ADAA) states that nearly 18% of the US population suffers from anxiety in any given year. Is anxiety as much of a widespread problem in Sri Lanka?
It’s difficult to say because there is very little data available which captures the Sri Lankan population and is statistically significant, largely due to cultural issues regarding mental health and lack of proper tools and management of self-report data.
However, if you look at the global rate of anxiety and related disorders on average, it must be at least around 10% or more, and this is regarding clinical generalised anxiety disorder only. It is important to note that anxiety and other mental health disorders are largely under-diagnosed in Sri Lanka as general awareness on mental health is very poor. Education and awareness, as well as alleviation of the cultural taboo, are paramount to this entire topic.
Can you name some causes of anxiety, both common and uncommon/unnoticed?
Some of the most common causes for anxiety are very simply a sudden change in environment or a life-changing event. The manifestation of anxiety differs from person to person but very often, certain events that cause trauma such as a divorce, a terror attack, or public speaking can trigger anxiety and/or its symptoms. It is important to emphasise that anxiety and stress-related disorders are a complex set of clinical issues and cannot be looked at as the same thing. Phobias and OCD are also part of the spectrum. This is why getting clinically assessed by a professional is important in order to specifically identify the presented problem in order to provide suitable intervention.
To most people, anxiety is a seemingly normal part of life. When does it become concerning?
According to the DSM (Diagnostic Statistical Manual) IV criteria, one has to display the symptoms of (GAD) Generalised Anxiety Disorder for three to six months, consistently. If the “panic attack” causes a disruption in one’s day to day life, that’s when there is cause for concern.
There seems to be many ways to classify anxiety disorders. What are they and what are some symptoms to identify them?
Many countries have specific clinical criteria for mental disorders, for example, I was trained under the DSM IV, the Diagnostic Statistical Manual of Mental Health Disorders in America. There are a variety of metrics available to measure anxiety, largely through self-report questionnaires, e.g. The Hamilton Anxiety Scale, etc. Here again it depends on the initial diagnosis of the client; it could be GAD, PTSD (Post Traumatic Stress Disorder), OCD, a specific phobia, or just a mild stress-related issue. The symptoms generally include fatigue, restlessness, inability to focus, irritability, tension, muscle pain, insomnia, hyperventilation, and symptoms related to panic disorder. It is important to rule out a clinical disorder if it is just a sporadic attack due to a sudden traumatic event.
Some disorders seem to be types that we can overcome with time, so when should we decide to get help?
As mentioned, if the individual feels they are unable to perform day-to-day activities properly and their anxiety causes disruption to main aspects of life such as relationships, physical health, work, etc., then getting help from a mental health professional is recommended.
Anxiety disorders concern a person’s mental health, but the ADAA also states that ‘if you suffer from an anxiety disorder, research suggests that you may run a higher risk of experiencing physical health problems’. What are some physical problems that can manifest as a result of anxiety?
Anxiety and stress are highly co-morbid, meaning they are interrelated and have very similar symptoms and often occur together. Therefore, many physical ailments can occur due to anxiety, namely heart disease, Irritable Bowel Syndrome (IBS), addiction/substance abuse, and even dermatological issues such as acne.
If you think you may be suffering from an anxiety disorder, what’s the first course of action to take? What sort of help is available to those suffering from anxiety disorders in Sri Lanka?
The first thing to do is to get clinically diagnosed to rule it out or provide a suitable intervention for long-term management of the problem. Psychiatrists and clinical psychologists will be able to do this. If you initially just want to talk to someone to get some general understanding, a counsellor will be sufficient, but if the symptoms are consistent and persist, then diagnosis from a clinical professional will be necessary. There are plenty of licensed counsellors, psychologists, and psychiatrists in Sri Lanka available on E-channelling. The CCC Foundation also has an excellent free hotline – 1333 – offering counselling services where they can help guide you through the issue. If it’s serious and they suspect clinical onset, they will make referrals to clinical professional.
Panic attacks seem to be a common result of various anxiety disorders. What are they and how do you know if you’re having one?
Panic attacks are specific occurrences of severe anxiety. For example, it will bring on the hyperventilation (short, rapid bursts of breath due to the feeling of not being able to breathe), the feeling of a heart attack, and complete paranoia of imminent danger. From a biological point of view, panic attacks and anxiety disorders cause an increase in cortisol and adrenaline – the hormones released when your body goes into “survival mode”. Too much production of these hormones has serious implications on your physical health in the long term. It’s important to recognise and label these symptoms once an attack occurs, as this will help relieve anxiety; the awareness of recognising that it is a panic attack relieves the panic itself.
If you’re having a panic attack yourself or realise that someone else is having a panic attack, how do you calm them down and get help?
Very often, cognitive behavioural therapists like me use grounding exercises. It is simply an activity which makes you hyper aware of your immediate surroundings and helps you to shift your focus from the emotional fear or anxiety to another more pleasant state.
An example of a grounding exercise could be to close your eyes and think of your loved ones like your children, and remind yourself of a happy moment spent together. This thought immediately causes your emotions to shift, thus relieving your anxiety.
Do you have any tips on managing anxiety that we can incorporate into our daily lives?
I recommend daily, focused deep breathing for five minutes, gratitude journals (where you simply write about the things you are most grateful for daily), and any physical activity; going for a walk, playing a sport, or even simply stretching whilst watching TV.
The idea is to MOVE. This helps increase oxygen in your brain and raises serotonin and dopamine neurotransmitter levels, which make you feel good naturally and increase blood circulation. Basic health practices such as eating non-processed, nutrition-dense foods, keeping hydrated, spending time with positive/caring people you love, and getting adequate sleep is also essential to ensure that your anxiety is managed effectively.
After the recent blasts that took place in the country, many people may suffer from anxiety about travelling in public transport or visiting places of worship. Do you have any advice or recommendations for them?
Honestly in times like these, vigilance is important because it is a matter of safety and security. So some fear is actually necessary for survival because it triggers survival mechanisms our bodies have developed in order to help us with the ordeals we face.
However, if there is no immediate threat and anxiety symptoms occur spontaneously, then the most practical, easiest step is to engage in deep, focused breathing (intense inhaling and exhaling) coupled with “positive self-talk” after each breath. For example, telling yourself that “everything is going to be okay, there is no sign of danger at this moment, and it is unlikely that there is a real rational reason to panic”.
The things we say to ourselves have immense power. The trick is to say the right thing in the right context, and the right emotion will follow.
There are also quite a few apps available to help people overcome certain anxiety disorders. Are there any you would recommend?
Yes, there are plenty. One I like to use often is Headspace. It helps to meditate with a guide giving instructions. The apps Happify and Calm also provide simple, clever ways to meditate and monitor your moods in a creative, visually pleasing way, and since it’s mobile based, it’s easily accessible and user-friendly.
“All anxiety and stress-related disorders are largely based on irrational belief systems,” concluded Shanelle. “We as human beings tend to exacerbate events and situations that happen. We are largely geared to problem-solve, which results in a negativity bias, making us exaggerate the “bad things” and minimise the “good things” that occur on a daily basis. Once we learn to challenge these irrational fears and beliefs and learn to recognise and appreciate the positive occurrences more often, the damage these disorders cause can be greatly reduced”.
Shanelle De Almeida is a licensed clinical psychologist specialising in cognitive behavioural therapy and marriage and couple therapy. She is currently employed as the Group Wellness Manager at Hemas Holdings PLC.