Anxiety is something everyone experiences. Although it can feel very unpleasant, it can help alert us to potential threats to our physical or psychological well-being, can motivate us to plan for the future, and, in the right amount, can even enhance our performance. However, if anxiety occurs too readily, is too intense, or persists for too long, it can cause considerable distress and impairment.
Anxiety is characterized by feelings of apprehension, nervousness, and worry about a future event or anticipated danger. It may be accompanied by physical symptoms such as muscle tension, racing or pounding heart, shortness of breath, or sweating. Other commonly occurring problems are irritability and difficulties with sleep and concentration. With severe anxiety, individuals may experience panic attacks, consisting of the rapid onset of intense fear or discomfort, along with a number of physical symptoms (such as those above) and/or cognitive symptoms (e.g., thinking one is having a heart attack, losing control, or dying).
People who struggle with anxiety often fear their own internal sensations and experiences (i.e., physical symptoms or emotions) as well as situations in which the outcome is uncertain. They also tend to experience themselves as ineffective and unprotected. Underneath their anxiety, many feel deeply vulnerable and insecure.
Anxiety negatively impacts our relationships, wears out our bodies, and curbs our full potential for happiness and satisfaction. It often causes us to limit our lives in some way–to avoid or dread things that we need or want to do, like finishing a project, meeting new people, asserting ourselves, or making an important decision. Preoccupied by anxious thoughts and feelings, people often feel discouraged and helpless, believing there is little they can do to change things. Fortunately, psychotherapy can be very effective for anxiety. Read about Treatment for Anxiety.
To learn more about specific types of anxiety, please follow the links below.
Specific Types of Anxiety
- Worry constantly about everyday things (e.g., financial, work-related, health, family)? – Read about Generalized Anxiety Disorder
- Fear being negatively judged or doing something embarrassing in front of others, causing you to avoid or dread certain social situations? — Read about Social Anxiety Disorder
- Worry about having intense, unpredictable panic attacks with physical sensations that make you believe you’re losing control, having a heart attack, or going crazy? — Read about Panic Disorder
- Fear being in situations that might be difficult to leave, or where no help is available, in the case of panic-like or embarrassing symptoms? — Read about Agoraphobia
- Have persistent and excessive fear of specific situations or things that you try to avoid at all times? — Read about Specific Phobia
If you answered “yes” to any of the above, psychotherapy might be an effective way for you to manage and overcome your anxiety. Read about Treatment for Anxiety.
Generalized Anxiety Disorder
Worry in moderated amounts has an adaptive function as it can help prepare us to solve problems and take action to overcome obstacles. However, a tendency to worry excessively and uncontrollably about numerous topics (e.g., relationships, family, finances, work and illness) can signal that something is wrong. It can also lead to symptoms such as high levels of tension, finding it difficult to relax, fatigue, inability to concentrate, irritability, and insomnia. Excessive worry and these associated symptoms often leave people feeling exhausted, helpless, hopeless and demoralized.
People who describe themselves as chronic worriers often avoid emotion and “live in the future”, given that worry is future oriented. Additionally, the research literature suggests that excessive worry is linked to being fearful of uncertainty, even when the probability of a negative event is low. People who worry excessively often ask ‘what if’ type questions to themselves, which only serves to highlight the possibility that negative and harmful events may occur. Over time, individuals recognize that they are caught in a longstanding pattern of overestimating risks and overestimating negative consequences; however, the more attempts to gain control and prevent negative events from occurring, the greater one worries. Research has indicated that treatment targeting intolerance of uncertainty can be beneficial for managing uncontrollable worry as well as learning to tolerate upsetting thoughts and feelings.
Social Anxiety Disorder
Social Anxiety Disorder is one of the most common anxiety disorders. Individuals with social anxiety experience intense fear in situations in which they may be exposed to scrutiny by others such as in social interactions, being observed, or performing in front of others. These situations prompt worry about potentially behaving in a way or showing symptoms of anxiety that will be embarrassing or judged negatively (e.g., fear others will view them as weak, incompetent, a loser, boring, unlikeable). Their anxiety is often accompanied by physical sensations such as blushing, sweating, and ‘freezing’.
People who have social anxiety describe being self-conscious, feeling as if they are in the spotlight. They often avoid situations that trigger their anxiety such as attending social events, meeting unfamiliar people, making small talk, dating, giving a presentation, participating in a group discussion, talking to people in positions of authority, expressing thoughts and opinions and asserting oneself. Social anxiety can lead to isolation, loneliness, reduced satisfaction and intimacy in relationships and may be a barrier to school and/or work-related achievement.
A key feature of Panic Disorder is repeated and unexpected panic attacks that occur in the absence of any identifiable danger. A panic attack involves a brief period of intense fear along with experiences such as racing heart, chest pain, dizziness, shaking, feeling of unreality, difficulty breathing, etc. Panic attacks become intense quickly and are accompanied by a sense of imminent danger or dread and an overwhelming urge to escape.
While many people have at least one panic attack in their life, Panic Disorder involves repeated panic attacks as well as persistent worry (e.g., about having further panic attacks) or changes in behaviour (e.g., avoiding situations that might trigger panic symptoms). For example, individuals with Panic Disorder often worry that their attacks indicate the presence of a life threatening illness (e.g., cardiac disease) and may make excessive visits to their family doctor or emergency departments. Others worry about embarrassing themselves, fainting, losing control or ‘going crazy.’ Such fears typically lead to avoidance of situations or places associated with past panic attacks or where they predict another could occur.
The cycle of fear and avoidance in Panic Disorder often leads to a narrowing of one’s sense of safety and comfort and a reduction in activities. Furthermore, individuals become acutely aware of normal bodily functions; this type of monitoring results in more scrutiny and interpretation for the early signs of a panic attack, which can create a constant state of hypervigilance, worry, and emotional exhaustion.
Without treatment, Panic Disorder may lead to chronic anxiety, unnecessary medical visits, and Agoraphobia, as well as reliance on medications (e.g., benzodiazepines such as Ativan/Lorazepam, Rivotril/Clonazepam, Xanax/Alprazolam,). Although benzodiazepines can provide some relief and a greater sense of security in the short-run, they can represent a form of avoidance and may erode one’s sense of efficacy. Psychological treatment, particularly CBT, has been shown to be clinically effective for Panic Disorder and Agoraphobia.
Agoraphobia is characterized by anxiety about being in places or situations from which escape might be difficult or help might not be available in the event of developing panic symptoms or other incapacitating or embarrassing symptoms (e.g., loss of bowel control, vomiting). This fear typically leads people to avoid a wide range of situations including crowds, waiting in lines, elevators, isolated places, traffic jams, tunnels, buses, airplanes, trains, movie theatres, being alone at home or being too far from home. Some people with agoraphobia are able to enter these situations but only with extreme discomfort and anxiety. In these cases, they typically find ways to make themselves feel safer such as positioning themselves near an exit for an easy escape, or bringing a family member or friend with them. People with agoraphobia often experience significant interference in their lives. They may be unable to work, travel, complete necessary errands (e.g., getting groceries), or attend appointments.
Specific phobias are characterized by intense and excessive or unreasonable fears related to a specific situation or object (e.g., small enclosed spaces, flying, needles, heights, spiders). People will usually do whatever they can to avoid the uncomfortable and often terrifying feelings associated with their phobia. This avoidance may make it difficult for them to go places they would like to go, or may interfere with work or social activities.
Treatment for Anxiety
People who suffer with anxiety disorders struggle with, avoid, and run away from their fear and anxiety. Research has shown that the most effective interventions for anxiety focus on helping you gradually approach and face what you fear and to allow and experience your feelings as opposed to avoiding through distraction, escape, or shutting down.
Cognitive Behaviour Therapy (CBT) is the most extensively researched psychotherapy for anxiety and has repeatedly demonstrated effectiveness for the range of anxiety disorders. Important therapeutic tasks involve developing alternative explanations for the causes and consequences of symptoms, challenging old beliefs, assumptions, and predictions that contribute to anxiety, and establishing more adaptive coping responses such as challenging fears directly through in vivo/real life exposure (i.e., confronting feared situations), interoceptive exposure (i.e., exercises to engage feared bodily symptoms), and imaginal exposure (i.e., confronting feared memories, images and emotions). Exposure helps to increase individuals’ tolerance for emotional discomfort and fear as well as gain confidence as they encounter situations they had previously avoided. CBT helps individuals move outside of the safety zone constricting their life to achieve their goals and live more in the present.
Emotion Focused Therapy also helps people directly engage and work with core fears and anxiety in the session as well as learn how to regulate and self-soothe in adaptive ways. Individuals are helped to actively experience and change unproductive ways of relating to themselves that contribute to anxiety and to modify core emotional states of vulnerability and insecurity underlying anxiety. Change occurs through accessing adaptive inner resources and needs that can transform a sense of oneself as weak and unable to cope, or as unsafe and alone. These processes lead to a more empowered and competent sense of self, greater awareness and skills for regulating anxiety and other emotions, and to ways of relating that are more accepting and compassionate.
Mindfulness strategies have increasingly become recognized as an effective source of intervention to address a range of concerns such as chronic pain, mood, and anxiety disorders in both group and individual therapy. One type of approach that incorporates mindfulness is Acceptance and Commitment Therapy (ACT). ACT aims to change the relationship you have with your unwanted experiences such as negative thoughts, emotions, memories, and physical sensations. Treatment involves gaining an awareness of your attempts to control, reduce, and avoid experiencing anxiety and compassionately learning to accept and move toward your fears. ACT helps you to clarify and choose a direction in your life that truly matters, which may have been put on hold due to feeling stuck in anxiety and fear. Finally, ACT is focused on committed behavioural change that involves taking steps and acting in a way that is consistent with your goals and values.
Please contact us to find out more about treatments for anxiety disorders.