Anxiety

Anxiety becomes a problem for children when it starts to get in the way of their day-to-day life. “We all get anxious at times, but some children seem to live a life of anxiety, where it’s not short-term and it’s not just an occasional thing,” says Paul Stallard, Professor of Child and Family Mental Health at the University of Bath.

“If you go into any school at exam time all the kids will be anxious but some may be so anxious that they don’t get into school that morning,” says Professor Stallard. “Some will sit in an exam and their mind freezes and they can’t get anything down on paper. This is when anxiety starts to interfere with what children need to do or would like to do in everyday life.”

Severe anxiety like this can harm children’s mental and emotional wellbeing, affecting their self-esteem and confidence. They may become withdrawn and go to great lengths to avoid things or situations that make them feel anxious.

Anxiety in teenagers may show itself in any of these ways according to the NHS website:

  • They may lack the confidence to try new things or seem unable to face simple, everyday challenges
  • find it hard to concentrate
  • have problems with sleeping or eating
  • Be prone to angry outbursts
  • have negative thoughts going round and round their head, or keep thinking that bad things are going to happen
  • start avoiding everyday activities, such as seeing friends, going out in public or attending school

Teenagers are more likely to suffer with social anxiety than other age groups, avoiding social gatherings or making excuses to get out of them. “At this age, the good opinion of your peer group is essential,” says Professor Stallard. “The fear is that, if you don’t like the same music or clothes, you will stand out as different and might be ridiculed or not accepted.” It is this Social Anxiety that has great relevance to the classroom.

Social anxiety disorder (social phobia) is a persistent and overwhelming fear of social situations. It’s one of the most common anxiety disorders.

Social anxiety disorder is much more than ‘shyness’. It can be intense fear and anxiety over simple everyday activities, such as shopping or speaking on the phone.

Many people sometimes worry about certain social situations, but someone with social anxiety disorder will worry excessively about them before, during and afterwards. They fear doing or saying something they think will be embarrassing or humiliating, such as blushing, sweating or appearing incompetent.

Social anxiety disorder is a type of complex phobia. This type of phobia has a disruptive or disabling impact on a person’s life. It can severely affect a person’s confidence and self-esteem, interfere with relationships and impair performance at work or school.

Social anxiety disorder often starts during childhood or adolescence and tends to be more common in women. It’s a recognised disorder that can be effectively treated.

 

Facts and Figures

The figures below are based on the finding of the latest ONS Child and Adolescent Mental Health Survey which was published in 2004.

  • 3.3% or about 290,000 children and young people have an anxiety disorder
  • 2.2% or about 96,000 children have an anxiety disorder
  • 4.4% or about 195,000 young people have an anxiety disorder

Anxiety is a type of fear usually associated with the thought of a threat or something going wrong in the future, but can also arise from something happening right now.

  • In 2013, there were 8.2 million cases of anxiety in the UK. 1
  • In England women are almost twice as likely to be diagnosed with anxiety disorders as men. 2
  • The one-week prevalence of generalised anxiety in England is 4.4%. 3
  • Be Mindful Online is an online mindfulness course offered by the Mental Health Foundation. Research on the online course in 2013 found that for the 273 people that completed the course, there was, on average, a 58% reduction in anxiety levels.

 

Generalized Anxiety Disorder (GAD)
According to the Teen Mental Health Organization Generalized Anxiety Disorder (GAD) is a disruption in how your brain controls the signals it uses to identify danger and initiate action to help you avoid it. However, in GAD, this signalling mechanism does not work as it should and you experience the danger signal when there is no danger. GAD is excessive anxiety and worry about everyday events that occurs over a prolonged period of time. Someone with GAD worries excessively about many different things and is not able to control his or her worry.

The worrying and anxiety causes serious emotional distress, and causes problems at school, at work, and in relationships. These feelings of anxiety usually also have physical components, including headaches, aches and pains, nausea, shaking and sweating.Feeling anxious in response to danger or in new situations is a perfectly normal response. It’s called the fight-or-flight response and helps us survive in dangerous situations. But these typical feelings are different from GAD. A person with GAD constantly feels tense and on edge, even when there is no danger present.

Up to about 9 percent of people will develop Generalized Anxiety Disorder in their lifetime, with women twice as likely as men. GAD rarely starts before adolescence, although some children who later develop the disorder have always been perceived as overly anxious. There is no one specific cause for GAD – multiple genetic and environmental causes play a role and it is not caused by the usual stresses of everyday life.

Generalized Anxiety Disorder, and other mental disorders, should only be diagnosed by a medical doctor, clinical psychologist, or other trained health provider who has spent time with the teenager and has conducted a proper mental health assessment. Diagnoses are complicated with many nuances. Please do not attempt to diagnose someone based on the symptoms you read in magazines or on the internet. If you are concerned, speak to a trained health professional.

 A variety of treatment options exist for GAD. Determining which course of action is appropriate for each individual should be done with the guidance of a trained health professional. Treatment options for GAD may include one (or a combination) of the following:

  • Psychological Treatments: Psychotherapy or “talk therapy” works by helping your brain better control your thoughts and emotions. The type of psychotherapy that has been found to be most effective for treating GAD in teenagers is called Cognitive Behavior Therapy (CBT). CBT helps people learn how to overcome their fears. It includes several components, including Cognitive Restructuring (e.g., changing the way someone thinks about his or her fears) and Exposure (e.g., gradually exposing the teenager to his or her fears while keeping him or her safe and teaching him or her effective strategies for coping with fear). Sometimes this therapy is provided in groups.
  • Medication: A variety of medications can be prescribed to relieve symptoms of GAD, including Serotonin Specific Reuptake Inhibitors (SSRIs) and some types of benzodiazepines. If medications are prescribed, they are usually used to help after psychotherapy has been started but results are not at expected levels.
  • Arousal Decreasing Techniques: Numerous techniques for decreasing physical arousal (that means: anxious feelings, rapid heart rate, rapid breathing) can help. These include: biofeedback, mindfulness, deep muscle relaxation, meditation, etc.
  • School supports: Sometimes certain adaptations can be made by the school to assist a student in coping with and managing his or her symptoms.
  • Community supports: Community supports can include peer support groups for teenagers, support groups for families, and other helpful resources.
  • Regular Routine: Maintaining a healthy, regular daily routine is very important for a person with GAD.

Remember, all treatments have the same goals: decrease symptoms and improve functionality; decrease risk of relapse; and promote recover. Think about it this way: Get well; Stay well; Be well.

Panic Disorder
The general day-to-day symptoms of panic disorder may be quite similar to generalized anxiety disorder. People with a panic disorder also experience something called panic attacks, which involve an attack that can be momentary or last for several minutes where a person is overwhelmed with terror. People with a panic disorder may experience repeated panic attacks when there is no reason to feel terrified. They also often change their regular daily activities to avoid stressors and the possibility of another panic attack. About 6 million people are diagnosed with a panic disorder, and nearly one third of them will go on to develop agoraphobia, a type of phobia explained below.

Phobias
Phobias are irrational or semi-irrational fears, such as an overwhelming terror about heights or being in enclosed spaces. They share similar symptoms to generalized anxiety disorder and panic disorder. There are two specific sub-types of phobias, they are agoraphobia and social anxiety disorder:

Agoraphobia
Agoraphobia, specifically, is the fear of not having an escape from embarrassing or emotionally difficult situations, often involving other people. People with agoraphobia often have panic attacks, and it is closely related to panic disorder. In extreme cases, people with agoraphobia can become so afraid of the tasks of daily living, such as driving or going to the grocery store or work, that they may have difficulty leaving the house. Nearly 2 million American adults are diagnosed with agoraphobia.

Social Anxiety
According to the UK based website Anxiety United social anxiety is different to being nervous about making a presentation, or going into a job interview. It is an intense fear which can take over a persons everyday life. They might feel like they are thinking about social situations all the time, and how to avoid them or mask a fear.

Social anxiety can be different from person to person, as with a lot of mental health problems. But there are some common situations which those with social anxiety can find terrifying. These include:

  • Speaking up within a group of people
  • Meeting new people
  • Speaking over the phone, or being the one to start a telephone call
  • Speaking to authority figures, such as a module leader, lecturer or industry expert.
  • Everyday situations, such as eating in public or going shopping.

Generally, those with social anxiety find it incredibly difficult to make eye-to-eye contact with others, especially strangers. They often worry what others may be thinking of them, and fear being criticised. It can produce feelings of low self esteem, and can sometimes even lead to other mental health issues arising, such as depression.

There are a lot of reasons why social anxiety can develop. Some studies suggest that if family members have suffered from anxiety, then a family member may also suffer. However, there is further study needed in this area.

The most common reason why people develop social anxiety is due to environmental factors and life experiences. A person may have had a very strict family, who criticised them a lot but praised them rarely. Alternatively, a persons upbringing may have been very sheltered and they have been overprotected and smothered. Social anxiety can stem from adolescence, from incidences of bullying or trying to meet the expectation of their peers. But people can also develop it during adulthood and later life.

If you identify these traits in your students or in a particular student, they may be suffering from social anxiety, if so there are many things they can do to try and get help.

As with any mental health issue, the best thing that they can do is talk about it. I know this might sound like an impossible challenge with social anxiety, but there are lots of ways around it. They can talk face-to-face or over the phone with someone they trust if they feel they can. On the other hand, a text, an email or a letter are also great ways to convey their feelings and worries to someone.

Online communities with like minded people – such as us at Anxiety United – are great places to discuss worries, getting everything off their chest and receiving great advice from people who have been in their shoes.

It is a good idea to speak with a GP if they can. A lot of surgeries now have online facilities to make appointments, so that they don’t need to speak to someone if they don’t feel they can.

All universities and most educational institutions will also have specialist teams and experts on hand to help, advise and support students who encounter issues concerning anxiety and depression. They will not only be able to offer personal support but also academic support, working closely with teachers and lecturers to formulate process’s to allow learning to continue with as little interruption or negative impact as possible.

When the student does see/speak to a GP, they may suggest trying a talking therapy, such as counselling or Cognitive Behavioural Therapy (CBT). They will likely discuss a diagnosis with the student and could even suggest some medication to help with their symptoms.

A tool which many social anxiety sufferers find useful is to create an ‘exposure stepladder’. The basic idea behind this is that it gives the student very gradual, small steps to reach an eventual goal, something which they feel they cannot achieve because of their social anxiety.

The student can write these simple steps down on a piece of paper. As an example, let’s say that their social anxiety means that they don’t feel that they could make a telephone call. In that example their stepladder may look a bit like this:

  • Sit with your phone in your hand, and dial a number (that of a friend or family member). You don’t need to press call. Just hear the tone of the numbers being punched in, familiarise yourself with what this sounds like, and remind yourself that you are completely safe.
  • Sit with your phone in your hand, and dial a number again. Press call, and listen to the sound of one ring, and hang up. Repeat. Once you get comfortable with getting to one ring, then wait for two rings. Then when you are comfortable with that, wait for three rings. Build your tolerance to the feeling of suspense.
  • Have your phone in your hand, and this time, call something like the talking clock, or something which you can just listen to, knowing that you don’t need to say anything at all. Know you are perfectly okay.
  • This time around, call up someone you know, and speak to them for a short amount of time… let’s say 30 seconds to 1 minute. When you get comfortable with this step, you can move on. Increase the amount of time you speak to the person by a minute at a time, until making a call doesn’t feel so daunting anymore. You know that you can hold a conversation, which will build your confidence.
  • Get the number for the place where you need to call (for example, to gain an internship, work placement or to speak to a landlord). Repeat step one, and just listen to the tone of the keys. You can do this as many times as you like until you are comfortable. Remind yourself that you are okay.
  • Get your facts ready for the phonecall so you feel as prepared as possible (e.g. details of who you want to speak to, what you are going to say, potential dates for an internship, or anything which relates to the reason you are calling). Know that you have everything you need in front of you. If you need to practice step two, that’s okay.
  • Make that all important phone call. Remember that you are completely in control. When you finish the phone call, record your feelings on a piece of paper. Realise your achievements and be proud of yourself.

The above is a specific example. Obviously in this case, the friend or family member you were practicing on would need to know you would be calling their phone and be okay with that! And this process would be carried out over probably a matter of weeks, not all in the same day. But it can be applied to a lot of situations, just make the steps small. The key is to make sure the student is comfortable with a step before they move onto the next one, and that they try not to skip any steps.

  • 1Fineberg, N., Haddad, P., Carpenter, L., Gannon, B., Sharpe, R., Young, A., Joyce, E., Rowe, J., Wellsted, D., Nutt, D. and Sahakian, B. (2013). The size, burden and cost of disorders of the brain in the UK. Journal of Psychopharmacology, 27(9), pp.761-770.
  • 2Martin-Merino, E., Ruigomez, A., Wallander, M., Johansson, S. and GarciaRodriguez, L. (2009). Prevalence, incidence, morbidity and treatment patterns in a cohort of patients diagnosed with anxiety in UK primary care. Family Practice, 27(1), pp.9-16.
  • 3McManus S, Meltzer H, Brugha T, Bebbington P, Jenkins R (eds) (2009). Adult Psychiatric Morbidity in England 2007: results of a household survey. NHS Information Centre for Health and Social Care. [online] Available at: http://www.hscic.gov.uk/pubs/psychiatricmorbidity07 [Accessed 25 Aug. 2015].
  • 4Mental Health Foundation (n.d). Evidence & Research. Available at http://bemindful.co.uk/evidence-research/ [accessed August 2015].