Stress, Worry, and Anxiety

STRESS, WORRY, AND ANXIETY

 WHAT IS IT?

We all get worried or stressed from time to time, it is part of life. Some people tend to feel stressed more often than others. It is important to know what the different types of worry is, and to distinguish it from anxiety.

Pressure

It is a natural condition caused by environmental demands we all need to face and manage on a daily basis. This could help us to function optimally if managed effectively.

For example, a day before a big exam, you would probably feel pressure, which would lead you to study more, and prepare effectively for the exam (Beck, 1964).

Stress

The dark side of pressure. This can be referred to as the disturbance of our equilibrium state. It could be detrimental to our functioning and health.

Stress would be when you feel overwhelmed by the pressure a day before the exam to the extent of not being able to study effectively (WHO, 2017).

Fear

Stress response to an actual threat which could lead to your life being in danger. Like when you are in a room with a tiger…You would experience the fight or flight response, which on a physiological level would prepare your body for the events to follow (NICE, 2019).

Anxiety

Stress response, but the threat is imagined, thus no real threat is present.

If someone has anxiety, they would be in a constant apprehensive state. The fight or flight response would be constantly activated, which impairs functioning on multiple levels, and interferes with your daily living.

“Anxiety is a worry about future events, and fear is a reaction to current events.” 

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WHAT DOES IT LOOK LIKE?

There are different types of anxiety, and therefore different diagnoses for anxiety including: Generalized Anxiety Disorder, Panic Disorder, Social Anxiety and Anxiety related to different phobias.

 

General symptoms of anxiety according to the DSM-5 (when taking all the different Anxiety diagnoses into account):

  • Obsession on the outcome of an event(s)

  • Struggling to concentrate, and finding it difficult to feel rested

  • Struggle to make decisions

  • Worrying about not being able to control your worry

  • Bodily/Physiological symptoms (such as sweating or shortness of breath)

  • Difficulty in sleeping (insomnia)

  • Worry more than the stressor requires normally (thus more fear than the actual situation requires)

 

WHY ME? WHY NOW?

Anxiety can affect anyone, at any time.

Globally

  • 3.6% (according to DSM criteria diagnosable with an anxiety disorder), thus 264 million people globally are affected by symptoms of anxiety.

  • 4.6% of the general female population, and 2.6% of the general male population.

  • From 2005 to 2015 there has been a 14.9% increase in people living with anxiety.

South Africa

  • 15% of the student population enrolled for further studying report moderate to severe symptoms of anxiety

 

Anxiety is usually caused by a combination of aspects or reasons, according to the DSM-5 (2013) and NICE (2019):

  • Genetics

  • Brain chemistry and biology

  • Life events such as crisis events or trauma, losing someone close, challenging relationships, an early aversive childhood experience or multiple experiences

  • One or more stressful situations

  • Change in routine, or a loss thereof

 

What now? How can you decrease the anxiety?

What can you as a student do in general?

Besides seeing a doctor and a counsellor, you can also help your anxiety by being patient with yourself and good to yourself. Don’t expect to get better immediately, but you will feel yourself improving gradually over time.

  • Exercising on a regular basis, being outside in nature, general healthy living, including diet and water intake.

  • Enough and effective sleeping habits. Avoid all night study sessions.

  • Relaxation techniques as described below.

  • Avoid drugs and too high amount of alcohol intake.

  • Plan your work approach, by breaking up larger tasks into smaller parts.

  • Spend time with supportive friends or family. Learn to talk about the anxious feelings or thoughts that you have with friends that have similar feelings.

  • Gather reliable information about anxiety.

“Tackling anxiety is not a once off exercise, but a way of living.”

TOOLS AND TECHNIQUES

To utilize when you feel extremely, acutely, overwhelmed, and you feel as if you might get a panic attack:

1. Paced breathing

Breathe in through the nose, keep in for 2 seconds, out through the mouth

  • 2 in, 2 seconds hold, 2 out

  • 3 in, 2 seconds hold, 3 out

  • 4 in, 2 seconds hold, 4 out

  • Put your hand on your diaphragm, focus on the counting and the breathing sensation. Feel your hand lift out with your stomach when you breathe in, and feel your hand move in with your stomach as you exhale.

2. Visualization as a relaxation technique

  • Imagine your most relaxed space (e.g. forest)

  • Think about all the details of that place

  • Focus on the experience of the senses - What do you see? What colours do you see? Is the light sharp or dim? What shapes can you see? What do you feel on your skin? What do you smell? What do you hear? What do you taste?

3. Mindfulness technique (Hayes, Strosahl & Wilson, 2012)

  • Focus on 5 things that you can see, and all the details of it

  • Focus on 5 things that you can hear

  • Focus on 5 things that you smell

  • Focus on 5 things that you can feel

  • Focus on 5 things that you can taste

4. Stay in the present

You can have a mantra that you repeat for yourself, to help you concentrate on the moment. Block thoughts of the future, or thoughts of the past, and allow yourself to think and concentrate on the current moment.

5. Fact-check your thoughts

Be the critical judge of the thought that is causing you anxiety by asking yourself the following questions (Beck, 1964):

  • Is this worrying thought realistic?

  • How likely is my worst case scenario thought to happen?

  • If the worst imaginable outcome occurs, would it be that bad?

  • Will I survive the worst imaginable outcome?

  • Would this change who I am?

  • Is this change really true or does it just seem that way?

  • How can I best prepare for whatever the outcome could be?”

6. Relabel current situation

Give your current emotion a different context by providing it with different meaning.

7. Write it out

  • Grab a pen and paper and start writing.

  • This will increase blood flow to your pre-frontal cortex, and decrease the blood flow to the limbic system (where the amygdala and hippocampus are). Thus, activating executive functioning and decreasing fight or flight state.

 

References:

Beck, J. S. (1964). Cognitive Therapy: Basics and Beyond. New York: Guildford Press.

Hayes, S.C., Strosahl K.D., & Wilson, K.G. (2012). Acceptance and Commitment Therapy: The process and practice of mindful change (2nd ed.). The Guildford Press: New York

NIMH. (2018). Anxiety disorder. Retrieved from https://www.nimh.nih.gov/health/topics/anxiety-disorders/index.shtml

NICE. (2019). Generalised anxiety disorder and panic disorder in adults: Management. Retrieved from https://www.nice.org.uk/guidance/cg113

WHO. (2017). Depression and Other Common Mental Disorders Global Health Estimates. Retrieved from https://apps.who.int/iris/bitstream/handle/10665/254610/WHO-MSD-MER-2017.2-eng.pdf

DSM – 5. (2013). Diagnostic and Statistical Manual of Mental Disorders (5th ed.). Retrieved from https://cdn.website-editor.net/30f11123991548a0af708722d458e476/files/uploaded/DSM%2520V.pdf

 

Compiled by Karen Pretorius (Counselling Psychologist at Thuso1777, Potchefstroom Campus)

Updated May 2020