As many as one in six South Africans suffer from anxiety, depression or substance-use problems (and this does not include more serious conditions such as bipolar disorder or schizophrenia), according to statistics released by the South African Depression and Anxiety Group (SADAG).

Anxiety is more than just feeling stressed or worried. While stress and anxious feelings are a common response to a situation where we feel under pressure, they usually pass once the stressful situation has passed, or ‘stressor’ is removed.

Anxiety is when these anxious feelings don’t go away – when they’re ongoing and happen without any particular reason or cause. It’s a serious condition that makes it hard to cope with daily life. Everyone feels anxious from time to time, but for someone experiencing anxiety, these feelings aren’t easily controlled.

Anxiety is one of the most common mental health conditions in our society. On average, one in six people – one in four women and one in five men – will experience anxiety at some stage in their life.

Anxiety is common, but the sooner people with anxiety get support, the more likely they are to recover.

Signs and symptoms of anxiety

The symptoms of anxiety conditions are sometimes not all that obvious as they often develop slowly over time and, given we all experience some anxiety at various points in our lives, it can be hard to know how much is too much.

Normal anxiety tends to be limited in time and connected with some stressful situation or event, such as a job interview. The type of anxiety experienced by people with an anxiety condition is more frequent or persistent, not always connected to an obvious challenge, and impacts on their quality of life and day-to-day functioning. While each anxiety condition has its own unique features, there are some common symptoms including:

Physical: panic attacks, hot and cold flushes, racing heart, tightening of the chest, quick breathing, restlessness, or feeling tense, wound up and edgy;
Psychological: excessive fear, worry, freeze or obsessive thinking;
Behavioural: avoidance of situations that make you feel anxious which can impact on study, work or social life.

These are just some of a number of symptoms that you might experience. They’re not designed to provide a diagnosis – for that you’ll need to see a professional – but they can be used as a guide.

Types of anxiety

Many people with anxiety experience symptoms of more than one type of anxiety condition, and may experience depression as well. It’s important to seek support early if you’re experiencing anxiety. Your symptoms may not go away if left untreated, they can start to take over your life.

There are different types of anxiety. The most common are:

Generalised Anxiety Disorder (GAD)

Most people feel anxious and worried from time to time, especially when faced with stressful situations like taking an exam, speaking in public, playing competitive sport or going for a job interview. This sort of anxiety can make you feel alert and focused, helping you get things done faster or perform at your best.

People with GAD, however, feel anxious and worried most of the time, not just in specific stressful situations, and these worries are intense, persistent and interfere with their normal lives. Their worries relate to several aspect of everyday life, including work, health, family and/or financial issues, rather than just one issue. Even minor things such as household chores or being late for an appointment can become the focus of anxiety, leading to uncontrollable worries and a feeling that something terrible will happen.

You may have GAD if the specific signs and symptoms are present for six months or more, and on more days than not. These include physical symptoms as well excessive worrying to the point that everyday activities like working, studying or socialising, become difficult.

People with GAD may have related disorders, most commonly depression, social phobia (characterised by avoidance of social situations) or other anxiety conditions. They may also misuse alcohol or drugs and may experience a range of physical health problems such as headaches or bowel complaints.

What causes GAD?

Often, a combination of factors may be involved in the development of GAD.

Biological factors: Some changes in brain functioning have been associated with GAD.

Family history: People with GAD often have a history of mental health problems in their family. However, this doesn’t mean that a person will automatically develop anxiety if a parent or close relative has had a mental health condition.
Stressful life events: People may be more at risk if they experience a major life change that causes stress, such as the birth of a child, the breakdown/loss of a close relationship, or moving house/job. Physical, sexual or emotional abuse also increase the risk of developing GAD, as do other traumatic experiences in childhood, such as the death of or separation from a parent.
Psychological factors: Some personality traits may put a person at greater risk of GAD, including: − being sensitive − being emotional or experiencing general nervousness − inability to tolerate frustration − feeling inhibited − having perfectionist tendencies.

Social anxiety

A person has an intense fear of being criticised, embarrassed or humiliated, even in everyday situations, such as speaking publicly, eating in public, being assertive at work or making small talk.

Social phobia

What is social phobia?

It’s perfectly normal to feel nervous in social situations where we might come under the attention of others, whether they’re strangers or people we know. Attending a formal function, giving a speech at a wedding, doing a presentation to work colleagues are likely to cause nervousness and anxiety, both in the lead-up and during the event.
However, for people with social phobia (sometimes known as social anxiety disorder), performing in front of others and social situations can lead to intense anxiety. They may fear being judged, criticised, laughed at or humiliated in front of others, even in the most ordinary, everyday situations. For example, the prospect of eating in front of others at a restaurant can be daunting for some people with social phobia.
Social phobia may occur in the lead up to or during in:
performance situations (such as having to give a speech or being watched while doing something at work)
situations involving social interaction (such as having a meal with friends, or making small talk).
Social phobia can also be specific; where people fear a specific situation or a few situations related to a specific fear (such as being assertive at work or with their friends).
Common symptoms of social anxiety include physical symptoms and psychological symptoms. The physical symptoms that can be particularly distressing for people with social phobia include:
excessive perspiration
trembling
blushing or stammering when trying to speak
nausea or diarrhoea.
These physical symptoms often cause further anxiety as the person fears others will notice – even though these signs are usually barely noticeable to those around them. People with social phobia also worry excessively that they will do or say the wrong thing and that something terrible will happen as a result. People with social phobia try to avoid situations where they fear acting in a way that’s humiliating or embarrassing. If avoidance isn’t possible, they endure the situation but can become extremely anxious and distressed and may try to leave the situation as soon as they can. This can have a serious negative effect on their personal relationships, professional lives and ability to go about their daily routine. A diagnosis of social phobia is based on having the typical symptoms, which cause significant distress or impairment of day-to-day functioning, and the symptoms are persistent for example at least six months.
What causes social phobia?
There are a number of causes of social phobia, including:
Temperament –Adolescents who are shy or socially inhibited are particularly at risk. In children, clingy behaviour, shyness, crying easily and excessive timidity may indicate temperaments that could possibly put them at risk of developing social phobia.
Family history – Social phobia can run in the family, in part because of a possible genetic predisposition.
Learned behaviour/environment – Some people with social phobia attribute the development of the condition to being poorly treated, publicly embarrassed or humiliated (e.g. being bullied at school).

Specific phobias

A person feels very fearful about a particular object or situation and may go to great lengths to avoid it, for example, having an injection or travelling on a plane. There are many different types of phobias.

What are specific phobias?

Concern or fear about certain situations, activities, animals or objects is not uncommon. Many people feel anxious when faced with a snake or spider, heights, or travelling by plane. Fear is a rational response to situations that can pose a threat to our safety.
However, some people react to objects, activities or situations (the phobic stimulus) by imagining or irrationally exaggerating the danger. Their feelings of panic, fear or terror are completely out of proportion to the actual threat. Sometimes the mere thought of the phobic stimulus, or the sight of it on TV, is enough to cause a reaction. These types of excessive reactions may be indicative of a specific phobia.
People with specific phobias are often well aware that their fears are exaggerated or irrational, but feel that their anxious reaction is automatic or uncontrollable. Specific phobias are often associated with panic attacks which the person experiences overwhelming physical sensations that may include a pounding heart, choking, nausea, faintness, dizziness, chest pain, hot or cold flushes and perspiration.
You may have a specific phobia if you:
have a persistent, excessive and unreasonable fear of a specific object, activity or situation, e.g. heights, the sight of blood or encountering a dog.
avoid situations where you may have to face the phobic stimulus, e.g. not walking down a street where there may be a dog. If the situation is unavoidable, you’re likely to feel high levels of distress.
find that the anxiety or avoidance associated with such situations makes it difficult to go about daily life (e.g. interferes with working, studying or seeing friends and family).
the anxiety and avoidance are persistent and have been present for at least 6 months or more
Specific phobias are generally divided into the following categories:
Animal type: fear that relates to animals or insects (e.g. fear of dogs or spiders).
Natural environment type: fear associated with the natural environment (e.g. fear of thunder or heights).
Blood/injection/injury type: fear associated with invasive medical procedures (e.g. injections), or with seeing blood or injury.
Situational type: fear of specific situations (e.g. elevators, bridges or driving).
Other: any other specific phobias (e.g. fear of choking, fear of vomiting).
You can have more than one type of specific phobia. Other specific phobias, such as the fear of public speaking, are more related to social phobia. Social phobia is a condition where people are overly concerned about how they appear to others.
What causes specific phobias?

Several factors are likely to increase your risk of developing a specific phobia. These include:

Temperament – A tendency to inhibition is common to many anxiety conditions.
A family history of mental health conditions – Specific phobias, such as animal phobias, may run in the family, in part due to a genetic predisposition. Traumatic experiences – If you’ve witnessed or experienced a traumatic event (e.g. being bitten by an animal or trapped in an enclosed space), you may feel extremely fearful of situations or objects associated with the event afterwards.

ANXIETY MANAGEMENT STRATEGIES

There are a range of strategies you can try to manage your anxiety. What works is different for everyone, and it can take time to find the strategies that work best for you. But remember, if your anxiety is proving difficult to manage seek support from a professional.

To curb anxiety the following 10 strategies could be helpful

Slow breathing: When you’re anxious, your breathing becomes faster and shallower. Try deliberately slowing down your breathing. Count to three as you breathe in slowly – then count to three as you breathe out slowly.
Progressive muscle relaxation: Find a quiet location. Close your eyes and slowly tense and then relax each of your muscle groups from your toes to your head. Hold the tension for three seconds and then release quickly. This can help reduce the feelings of muscle tension that often comes with anxiety.
Healthy lifestyle: Keeping active, eating well, going out into nature, spending time with family and friends, reducing stress and doing the activities you enjoy are all effective in reducing anxiety and improving your wellbeing.
Stay in the present moment: Anxiety can make your thoughts live in a terrible future that hasn’t happened yet. Try to bring yourself back to where you are. Practising meditation can help.
Take small acts being brave: Avoiding what makes you anxious provides some relief in the short term, but can make you more anxious in the long term. Try approaching something that makes you anxious – even in a small way. The way through anxiety is by learning that what you fear isn’t likely to happen – and if it does, you’ll be able to cope with it.
Self talk corrections: How you think affects how you feel. Anxiety can make you overestimate the danger in a situation and underestimate your ability to handle it. Try to think of different interpretations to a situation that’s making you anxious, rather than jumping to the worst-case scenario. Look at the facts for and against your thought being true.
Plan worry time: It’s hard to stop worrying entirely so set aside some time to indulge your worries. Even 10 minutes each evening to write them down or go over them in your head can help stop your worries from taking over at other times.
Get to know your anxiety: Keep a diary of when it’s at its best – and worst. Find the patterns and plan your week – or day – to proactively manage your anxiety.
Be kind to yourself: Remember that you are not your anxiety. You are not weak. You are not inferior. You have a mental health condition. It’s called anxiety
.Learn from others: Talking with others who also experience anxiety – or are going through something similar – can help you feel less alone.