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. (4,23,24,25)

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. (4,23)

Emotional

  • Feelings of apprehension or dread
  • Watching for signs of danger in otherwise safe spaces
  • Anticipating the worst
  • Trouble concentrating
  • Feeling tense, jumpy and irritable
  • Feeling like your mind’s gone blank

Physical

  • Pounding heart, sometimes so extreme that you may think you’re having a heart attack
  • Sweating
  • Headaches
  • Stomach upset
  • Dizziness
  • Frequent urination or diarrhea
  • Shortness of breath
  • Muscle tension or twitches
  • Shaking or trembling
  • Insomnia

Anxiety/Panic Attacks (23)

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. (25)

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. (4,24)

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. (24, 25) 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 (4)

  • Surge of overwhelming panic
  • Feeling of losing control or going crazy
  • Heart palpitations or chest pain
  • Feeling like you’re going to pass out
  • Trouble breathing or choking sensation
  • Hyperventilation
  • Hot flashes or chills
  • Trembling or shaking
  • Nausea or stomach cramps
  • Feeling detached or unreal

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. (4)

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. (4)

Obsessive-compulsive disorder (OCD) is characterized by unwanted thoughts or behaviours that seem impossible to stop or control. (4)

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. (4)

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. (4)

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, hypervigilance, startling easily, withdrawing from others, and avoiding situations that remind you of the event. (4)

SUICIDAL THOUGHTS/BEHAVIOURS (4)

Sadly, our industry has seen a steady increase of suicides year over year. The pressures of hospitality – the long hours, the “keep smiling, it’s showtime” mantras, the abuse of alcohol and drugs as a coping mechanism, harassment from co-workers, bosses and customers, and the financial stress, create a perfect storm for suicidal tendencies. Most of us know someone who has attempted suicide, if not succeeded. World-wide attention to this crisis was caught by the sudden and tragic death of Anthony Bourdain, but veterans of this business know it has been rampant for a long time. This is one of the major factors to the building of this foundation – to get us talking, to get us help and to get us healthy.

The underlying motivation for suicide is the feeling of utter despair and hopelessness; how a

person reaches that point is what varies from individual to individual. Some symptoms include:

  • Depression or sadness all the time – Note that suicide prevention experts say untreated depression is the number one cause of suicide.
  • Talking or writing about death or suicide
  • Writing a will, taking extreme steps to prepare for your death
  • Giving away possessions, especially those the person holds most dear
  • Dramatic mood changes
  • Change in eating or sleeping habits
  • Loss of interest in activities – especially those previously enjoyable
  • Poor work or school performance
  • Abuse of drugs or alcohol
  • Change in personality
  • Withdrawal from family members and friends
  • Feelings of hopelessness, being helpless or feeling trapped
  • Demonstrating strong feelings of anger or rage
  • Acting impulsively or recklessly
  • Feeling excessive shame and/or guilt

In addition, suicidal people who are demonstrating warning signs are at greater risk if there has been: (4, 7, 17, 19, 22)

  • A recent loss of a close relationship
  • A change (or anticipated change) in work circumstances
  • A change in health, diagnosis of disease or chronic pain or illness
  • Increased misuse of alcohol or other drugs
  • A history of suicidal behaviour or history of suicide attempts in the family
  • Current major depression

** If you are feeling suicidal, call 911 immediately. Reach out to a friend and stay xxxxxxx

** If you think someone is contemplating suicide, immediate action is needed. Call 911, find your friend xxxxxxx

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 – 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 (2, 4)

Questions to Ask Medical Professionals

What is causing my depression? 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?

More Information on Suicide

Men commit suicide at a rate four times higher than that of women. (13,14,21) Women, however, make 3 to 4 times more suicide attempts than men do (15), and women are hospitalized in general hospitals for attempted suicide at 1.5 times the rate of men (15,16). Studies indicate that there is a significant correlation between a history of sexual abuse and the lifetime number of suicide attempts, and this correlation is twice as strong for women as for men (19,21,29,17).

In Canada, suicide accounts for 24 percent of all deaths among 15-24-year-olds and 16 percent among 16-44-year-olds. Suicide is the second leading cause of death for Canadians between the ages of 10 and 24. Seventy-three percent of hospital admissions for attempted suicide are for people between the ages of 15 and 44. (27,28)

People with mood disorders are at a particularly high risk of suicide (studies indicate that more than 90 percent of suicide victims have a diagnosable psychiatric illness, and suicide is the most common cause of death for people with schizophrenia. Both major depression and bipolar disorder account for 15 to 25 percent of all deaths by suicide in patients with severe mood disorders. (18,19)

Late July and August have the highest suicide rate out of all the months of the year. Some studies suggest that the increase is due to seasonal change and that this period is one that often brings about changes in personal situations. It is suggested that all these elements of change – whether dramatic changes are happening in someone’s life, or if they feel defeated because their situation seems never to change – can lead people to suicide. (27,30,34)

Worldwide, many of those (65-95%) who complete suicide have a mental disorder. (30,33). Indeed, the risk of suicide is up to 15 times higher among people who have a mental disorder compared to those who do not.(30) Although mental disorders are considered a risk factor in Asian countries as well, there is evidence that they are not as frequent in suicidal behaviours, but that impulsiveness plays a greater role (26).

High suicide risk is particularly associated with acute episodes of illness, recent hospital discharge (almost half commit suicide before their first follow-up appointment), or recent contact with a mental health service. Approximately 25% of people who complete suicide will have been in contact with a mental health agency in the year before their death (7,8). Specific mental disorders that have been linked to suicide include depression, substance abuse, schizophrenia, and personality disorders.(30,31,38) Substance abuse and personality disorders are more common among men, and depression is more common among women. (35)

Co-occurring conditions are particularly common among those who complete suicide. For example, depression combined with alcohol abuse occurs in about two-thirds of those who complete suicide. (7)

Therefore, the presence of a mental and/or substance use disorder is one of the strongest predictors of suicide, making the identification and treatment of psychiatric and substance use disorders an important prevention strategy.

Protective Factors:  are skills, strengths, or resources that help people deal more effectively with stressful events and reduces the likelihood of attempting or completing suicide. They enhance resilience and help to counterbalance risk factors. (10,37)

Coping skills

Resiliency

Reasons for living

Being married or a parent

External/Environmental Protective Factors

Strong relationships, particularly with family members

Opportunities to participate in and contribute to school and/or community projects/activities.

A reasonably safe and stable environment

Restricted access to lethal means

Responsibilities/duties to others

Pets

Attitudes, values, and norms prohibiting suicide e.g. strong beliefs about the meaning and value of life

Social skills e.g. decision-making, problem-solving, and anger management

Good health and access to mental and physical health care

Strong connections to friends, family, and supportive significant others

Cultural, religious or spiritual beliefs that discourage suicide

A healthy fear of risky behaviors and pain

Hope for the future; optimism

Sobriety

Medical compliance and a sense of the importance of health and wellness

Impulse control

Strong sense of self-worth or self-esteem

Sense of personal control or determination

Access to a variety of clinical interventions and support for help seeking

Strengthening these factors should be an ongoing process to increase resiliency during the presence of increased risk factors or other stressful situations.(1,3,5)