Anxiety

Anxiety is a normal reaction to danger, the body’s automatic, adrenaline-fuelled fight-or-flight response that is triggered when you feel threatened, under pressure, or are facing a stressful situation.

When it interferes with relationships and daily activities, we’ve moved from normal reactions into the territory of an anxiety disorder. Despite their different forms, all anxiety disorders illicit an intense fear that outweighs the situation at hand.

Episodes of intense panic or fear, anxiety attacks usually occur suddenly and without warning. Sometimes there’s an obvious trigger—getting stuck in an elevator, for example, or thinking about the big speech you have to give—but in other cases, the attacks come out of the blue.

Anxiety attacks usually peak within 10 minutes, and they rarely last more than 30 minutes. But during that short time, the terror can be so severe that you feel as if you’re about to die or totally lose control.

The physical symptoms of anxiety attacks are themselves so frightening that many people feel like they’re having a heart attack. After an anxiety attack is over, you may be worried about having another one, particularly in a public place where help isn’t available or you can’t easily escape.  As a result, you can feel like you are in a constant loop of anxiety from a panic attack, to being afraid of having a panic attack.

Symptoms

Emotional

  • Surge of overwhelming panic
  • Feeling tense, jumpy and irritable
  • Feelings of apprehension or dread
  • Feeling of losing control or going crazy
  • Watching for signs of danger in otherwise safe spaces
  • Anticipating the worst
  • Trouble concentrating
  • Feeling like your mind’s gone blank
  • Feeling detached or unreal

Physical

  • Shortness of breath
  • Hyperventilation
  • Trouble breathing or choking sensation
  • Feeling like you’re going to pass out
  • Heart palpitations or chest pain
  • Muscle tension or twitches
  • Trembling or shaking
  • Hot flashes or chills
  • Sweating
  • Headaches
  • Dizziness
  • Stomach upset
  • Nausea or stomach cramps
  • Frequent urination or diarrhea
  • Insomnia

Anxiety Disorders

Generalized anxiety disorder (GAD)

Constantly worried and afraid, distracted from day-to-day activities, or always feeling that something bad is going to happen, people with GAD feel anxious nearly all of the time, though they may not even know why. Anxiety-related to GAD often shows up as physical symptoms like insomnia, upset stomach, restlessness, and fatigue.


Panic attacks and panic disorder

Panic disorder is characterized by repeated, unexpected panic attacks, as well as fear of experiencing another attack. A panic disorder may also be accompanied by agoraphobia, which is the fear of being in places where escape or help would be difficult in the event of a panic attack, generally speaking, anywhere in public. 


Obsessive-compulsive disorder (OCD)

OCD is characterized by unwanted thoughts or behaviours that seem impossible to stop or control.


Phobias

A phobia is an unrealistic or exaggerated fear of a specific object, activity, or situation that in reality, presents little to no danger. Common phobias include fear of animals (such as snakes and spiders), fear of flying, and fear of heights. In the case of a severe phobia, might go to extreme lengths to avoid the thing you fear. Unfortunately, avoidance only strengthens the phobia.


Social anxiety disorder

If you experience a debilitating fear of being seen negatively by others and humiliated in public, you may have a social anxiety disorder, also known as social phobia. Social anxiety disorder can be thought of as extreme shyness. In severe cases, social situations are avoided altogether. Performance anxiety (better known as stage fright) is the most common type of social phobia. 


Post-traumatic stress disorder (PTSD)

PTSD is an extreme anxiety disorder that can occur in the aftermath of a traumatic or life-threatening event. PTSD can be thought of as a panic attack that rarely, if ever, lets up. Symptoms of PTSD include flashbacks or nightmares about what happened, hyper vigilance, startling easily, withdrawing from others, and avoiding situations that remind you of the event.

Treatment Options

Exposure therapy – encourages you to confront your fears and anxieties in a safe, controlled environment. By gradual exposure to the feared object or situation, either in your imagination or in reality, you gain a greater sense of control, and as you face your fear without being harmed, your anxiety will diminish.

Cognitive behaviour therapy (CBT) – helps you identify and challenge the negative thinking patterns and irrational beliefs.

Cognitive-behavioural therapy and exposure therapy are types of behavioural therapy, meaning they focus on behaviour rather than the underlying psychological conflicts or issues from the past.

Dialectical behaviour therapy (DBT) This approach works towards helping people increase their emotional and cognitive regulation by learning and assessing what triggers them, and how to apply specific coping methods to avoid undesired reactions. DBT combines standard cognitive behavioural techniques for emotion regulation and reality-testing with concepts of distress tolerance, acceptance, and mindful awareness.

Electroconvulsive Therapy (ECT) For very severe, persistent depression. Not shock therapy but rather very low-level electrical pulses. It is often effective and has few side effects.

Eye movement desensitization and reprocessing (EMDR) is a form of psychotherapy in which the person being treated is asked to recall distressing images while generating one type of bilateral sensory input, such as side-to-side eye movements or hand tapping. Unlike CBT with a trauma focus, EMDR does not involve (a) detailed descriptions of the event, (b) direct challenging of beliefs, (c) extended exposure or (d) homework.

Selective serotonin re-uptake inhibitors (SSRIs) – block the reabsorption (re-uptake) of serotonin in the brain, making more serotonin available.

Tricyclic Antidepressants – This seems to stop neurotransmitters from binding with specific receptors on the nerves. Because the norepinephrine and serotonin refuse to bind to the receptors, they seem to build up in the areas between the nerve cells. As a result, the neurotransmitter levels rise.

Monoamine oxidase inhibitors (MAOIs) – Monoamine oxidase is a natural enzyme that breaks down serotonin, epinephrine, and dopamine. MAOIs block the effects of this enzyme. As a result, the levels of those neurotransmitters might get a boost.

Mixed Re-uptake AntidepressantsDual inhibition of serotonin and norepinephrine re-uptake can offer advantages over other antidepressant drugs by treating a wider range of symptoms.

Nutraceuticals or “medical food” is a prescription strength form of folate, also known as one of the essential B vitamins, B9.

Natural Drugs – CBD, Mushrooms.

It is important to discuss all symptoms you may have with your doctor to get the most appropriate therapy!

Questions to Ask Medical Professionals

What is causing my anxiety? Is it another health problem or medication?

Which treatments are right for me (medication, counselling, or both)? Why?

What medication side effects should I look out for?

If I notice side effects, who should I contact, you or someone else in your office?

Are there any foods, alcohol, or medications that I shouldn’t take while I’m on this medication?

How long will it take before I start feeling better?

How long do I need to take this medication and/or be in therapy?

What if this doesn’t work? What’s next?

Will my insurance pay for it? How much will I have to pay?

What if I can’t pay for the medication? Are there any free as samples from the company that makes it?

Should I think about experimental treatments or clinical trials?

Is there anything else I can do to feel better?.

How do I talk about my depression with other people?

Should I talk to my advisor or my boss about it?

What should I do if I start to feel suicidal?

Resources

Crisis Services Canada
Canadian Mental Health Association
E-Mental Health
Find a Therapist

Regional Support Services

British Columbia

BC Crisis Centre & Mental Health Support 
310-6789
1-800-SUICIDE (784-2443)
#211

Reduced Cost Counselling Options in Vancouver

Crisis Intervention & Suicide Prevention Centre of BC
Vancouver Coastal Region: 604-872-3311
Sunshine Coast/Sea to Sky: 1-866-661-3311

BC Interior Crisis Line Network 
(Serving all BC Interior Region)
1-888-353-CARE (2273)

Crisis Prevention, Intervention 
& Information Centre for Northern BC
(Serves all of Northern BC)
250-563-1214 
1-888-562-1214

Vancouver Island Crisis Society
1-888-494-3888

North Island Crisis & Counselling Centre Society
250-949-6033

Alberta

Distress Centre 
1-403-266-HELP 

Mental Health Helpline 
1-877-303-2642 

Distress Line of Southwestern Alberta 
(Serving Chinook health region) 
1-888-787-2880 (403) 327-7905 

The Support Network Distress Line 
(Serving Edmonton and surrounding areas) 
1-800-232-7288

Manitoba

Klinic Crisis Line 
1-888-322-3019 

Crisis Stabilization Unit 
(Serving Winnipeg Health Region) 
204-940-3633 

Mental Health Crisis Service 
(Serving Central Regional Health Authority) 
1-888-310-4593

Saskatchewan

Saskatoon Crisis Intervention Service 
306-933-6200 

Saskatchewan HealthLine 
#811 or 1-877-800-0002 
306-766-6600

Ontario

Connex Ontario 
1-866-531-2600 

Good2Talk 
1-866-925-5454 

District and Crisis Ontario Helplines 
416-486-2242 

Gerstein Crisis Centre 
416-929-5200 

Mental Health Crisis Line 
Ottawa: 613-722-6914 
Greater Ottawa area: 1-866-996-0991

New Brunswick

Chimo Helpline 
1-800-667-5005 
Fredericton area: 450-HELP (4357)

Yukon

Yukon Crisis Line 
403-668-9111

USA

Mental Health America 
1-800-273-8255 
Text ‘MHA’ to 741741