It’s normal to get anxious when stressful or difficult situations arise, but when the symptoms of nervousness persist over a significant period of time they can affect how we go about our everyday lives.
In light of 10 October being World Mental Health Day, we spoke to Lecturer & Clinical Psychologist, Dr. Ng Siew Li and Senior Lecturer & Research Coordinator, Dr. Eugene Tee, both who teach at HELP University, to find out more about anxiety and what can be done to manage the symptoms.
1. What is anxiety and how does having anxiety differ from just being nervous? What are some symptoms to look out for?
Anxiety is an emotional state that is experienced when someone anticipates possible future threats or uncertainties. When someone is anxious, the sense of uneasiness or nervousness is often accompanied by feelings of tension, worried thoughts, and physical symptoms such as sweating and heart palpitations.
It is normal to feel anxious and afraid when we are faced with threats or uncertainties. When these emotional experiences persist beyond a period that would be considered as appropriate, however, they can create significant distress, and adversely affect your daily life and day-to-day functioning. At its extreme, such experiences can result in a person being diagnosed with an anxiety disorder. The clinical diagnosis, of course, depends on the types of objects, situations, or thoughts that triggers the anxiety. There are about seven types of anxiety disorders; each type has its own set of symptoms to look out for. For example, symptoms for social anxiety disorder include having an intense fear of social situations which lasts for at least six months.
Generally, it is helpful to identify the reason you are feeling anxious and to see if your feelings and avoidant behaviours are affecting your daily activities. For example, if someone will not leave their house because they are afraid of being in crowded areas or spending more than an hour each day checking and rechecking whether he or she has locked the house door, these are generally considered as excessive and as symptoms of anxiety disorders.
2. What is a panic attack?
A panic attack is a type of fear response, and fear in this case refers to an emotional response to real or perceived immediate threats. Panic attacks are quite commonly seen in people with anxiety disorders, but they can also accompany other types of mental disorders. Examples of symptoms include increased heart rate, trembling or shaking, sweating, or sensations of shortness of breath. Another experience often reported by people who suffer panic attacks is the fear of dying (usually quoted as a fear of dying from a heart attack from increased heart palpitations). They may also report experiences of ‘dissociation’ — a sense that their immediate experience is ‘not real,’ or that they are reporting seeing themselves from a third-person view.
3. Is it more common for women to suffer from anxiety more than men?
Most anxiety disorders are more common in women than in men, with approximately 2:1 ratio. There are also different prevalence rates for the various types of anxiety disorders.
4. Is anxiety prevalent in Asia even though it is not often spoken about? What effect does Asia's 'toughen-up' attitude and lack of awareness have on people who may suffer from anxiety?
The rates of people with anxiety disorders are generally higher in the United States and European countries compared Asian, African, or Latin American countries. For example, 12-month prevalence rate for social anxiety disorder is about 7% in the US, but only about 0.5 to 2% in other parts of the world. The criteria used to identify these disorders are formed mainly based on research done in the West, and thus may not capture how people with intense anxiety may look like in non-western cultures. This may explain why rates are lower in these other countries.
In many Asian countries, mental health concerns are still considered a taboo topic, and there are people who would go out of their way to avoid seeking mental health services despite having difficulties dealing with their own emotions. They not only risk worsening their condition, but also lose time and opportunity to do what they could do (e.g., make a living, spending quality time with friends and family) if they put off getting the help they need. For this reason, it may be that reported rates of anxiety, and anxiety-related disorders in Asia are lower — but under no circumstances should we automatically assume that this means that rates of anxiety are any less prevalent in our region. A recent study by the World Health Organization (WHO) reports a 4% and 2% rate of prevalence of anxiety disorders among respectively for women and men in South-East Asia.
Personally, we think that the ‘toughen-up’ mentality in Asia may be partly due to perceptions and assumptions that experiencing mental health disorders is shameful, reflecting on the individual’s lack of ability to cope with the demands of modern-day expectations or failing to live up to societal expectations.
5. What factors can make anxiety worse?
Some people are more at risk of developing anxiety disorders. For instance, those with temperaments that are more prone to experiencing upsetting emotions are more likely to develop anxiety disorders. In addition, environment influences such as parental overprotectiveness and physical or sexual abuse also put someone at a higher risk for developing anxiety disorders.
Stress can often exacerbate anxiety symptoms, as does certain habits such as smoking and coffee consumption. When anxiety kicks in, you may be tempted to distract yourself or walk away from the source of your anxiety; however, while these strategies may work in the short run, they rarely help in directly addressing the root of one’s anxiety. Avoidant behaviours are common; yet, the more you avoid, chances are your anxiety will get worse. Coping strategies — drinking alcohol, for instance, may further exacerbate anxiety experiences.
6. In situations where it is difficult for someone to avoid the factors mentioned above, how can a person manage their anxiety? Overall, what are some changes a person can make to help them manage their anxiety?
Physical and mental health typically go hand in hand. Lifestyle practices such as having adequate sleep, exercise regularly, and eat healthily are important for maintaining both physical and mental health. In cases where anxiety has kicked in, you may find some relaxation techniques useful. For example, techniques such as deep breathing and progressive muscle relaxation have been found to be helpful in managing anxiety symptoms. In addition, some people find mindfulness exercises and meditation to be helpful. In situations where you find it difficult to manage your anxiety, seeking professional help could be the next step. Effectiveness of techniques such as cognitive challenging and exposure therapy in treating anxiety has been well-studied.
7. What can you do to support someone who is suffering from anxiety? What are some things you shouldn't do or say to them?
People who have a good social support system are more likely to have lower levels of anxiety and greater resilience to stress. It is therefore important to be supportive of your loved ones, especially when they are experiencing mental health concerns. It is sometimes particularly difficult watching someone you care about experiencing anxiety symptoms, and you may be tempted to soothe and give in to their request of avoiding what they fear or makes them anxious. However, avoidance can sometimes prolong their anxiety symptoms. Thus, it may be better to understand what and why this person is anxious and see if the anxiety and avoidant behaviors are excessive and adversely affecting their daily activities. If they are, recommending professional services and supporting them through the process of recovery could be more helpful.
 American Psychiatric Association. (2013). Diagnostic and statistical manual of mental disorders (5th ed.). Washington, DC: Author.
 World Health Organization. (2017). Depression and other common mental disorders: Global health estimates. Available at: http://apps.who.int/iris/bitstream/handle/10665/254610/WHO-MSD-MER-2017.2-eng.pdf
 Chambless, D.L. & Ollendick, T.H. (2001). Empirically supported psychological interventions: Controversies and evidence. Annual Review of Psychology, 52, 685-716.
 Southwick, S. M., Vythilingam, M., & Charney, D. S. (2005). The psychobiology of depression and resilience to stress: implications for prevention and treatment. Annual Review of Clinical Psychology, 1, 255 – 291. doi: 10.1146/annurev.clinpsy.1.102803.143948