Anxiety #1 of 6

What is Anxiety?

“I wish I found some better sounds no one’s ever heard

I wish I had a better voice that sang some better words

I wish I found some chords in an order that is new

I wish I didn’t have to rhyme every time I sang

I was told when I get older all my fears would shrink

But now I’m insecure and I care what people think

My name’s ‘Blurryface’ and I care what you think

My name’s ‘Blurryface’ and I care what you think

Wish we could turn back time, to the good old days

When our momma sang us to sleep but now we’re stressed out (oh)

Wish we could turn back time (oh), to the good old days (oh)

When our momma sang us to sleep, but now we’re stressed out”

- “Stressed Out” by Twenty-One Pilots

Wishing to be unique, wishing to be better, wishing fears would shrink, wishing for a clear identity and not being “Blurrryface” and caring what others think.  As much as I like listening to this song, the distance between expectations (what I’m wishing for), the unknown and reality makes me questions my identity and become anxious also.  In fact, we all become anxious. It’s even useful to make us aware of potential danger or help us focus when something important, like a test, is coming up.

Because we all experience some level of anxiety frequently, it can be hard to tell the difference between “healthy” natural anxiety and someone struggling with an anxiety disorder.  An anxiety disorder differs from natural anxiety in 3 ways:

1. It is more severe.

2. It is long lasting.

3. It interferes with the person’s studies, other activities, and family and social relationships.

WebMD has a brief quiz to help you know if what you’re feeling is natural anxiety or at a level that professional support might be helpful.  What’s Worrying You? The Facts About Anxiety

Anxiety #2 of 6

The symptoms of anxiety disorders in adolescents will vary according to length of illness, presence of support system, and type of anxiety disorder.  Symptoms of an anxiety disorder may come on gradually and linger, or they may come about suddenly.  Rarely will one person display all these symptoms.  And all of these could be symptoms of something else (for example, running a sprint).  However, when a variety of these signs appear severe, long lasting and interferes with a person’s life an anxiety disorder could exist.

Physical

• ~Pounding heart, chest pain, rapid heartbeat, and blushing

• ~Rapid, shallow breathing, and shortness of breath

• ~Dizziness, headache, sweating, tingling, and numbness

• ~Choking, dry mouth, stomach pains, nausea, vomiting, and diarrhea

• ~Muscle aches and pains (especially neck, shoulders, and back), restlessness, tremors, and shaking

Psychological

• ~Unrealistic or excessive fear and worry (about past and future events)

• ~Racing thoughts or mind going blank

• ~Decreased concentration and memory

• ~Indecisiveness

• ~Irritability

• ~Impatience

• ~Anger

• ~Confusion

• ~Feeling on edge

• ~Nervousness

• ~Sleep disturbance

• ~Vivid dreams

Behavioral

• ~Avoidance of situations

• ~Obsessive or compulsive behavior

• ~Distress in social situations

• ~Phobic behavior

• ~Increased use of alcohol or other drugs

What this might look like at home, young people may

• ~Complain of headaches and other physical problems to avoid going to school

• ~Be tearful in the morning, saying they do not want to go to school

• ~Spend more time doing homework or express unnecessary concerns that the work is not good enough

• ~Demand constant reassurance from parents

• ~Be touchy and irritable in interactions with family

• ~Spend a long time getting ready for social occasion, worrying about their appearance or what they might do, or decide at the last minute not to attend the social occasion

At school, young people may

• ~Be extremely well behaved and quiet, fearful of asking questions

• ~Demand extra time from teachers, asking questions constantly and needing a great deal of reassurance

• ~Not hand in assignments on time because the work is seen as less than perfect

• ~Complain of sudden, unexplained physical illness, such as a stomachache or headache, when exams or presentations have been scheduled

In a social setting, young people may

• ~Avoid meeting new people or socializing with groups, spending time with only a few safe friends

• ~Use alcohol or other drugs at parties to make it easier to talk to people

• ~Leave social events early

• ~Avoid speaking up for fear of embarrassment

Source:  Mental Health First Aid USA 2016 National Council for Behavioral Health

Anxiety #3 of 6

Feeling Anxious Today? And Other Risk Factors 

Ever been told how hard your parents had it when they were kids?  That you should be grateful for the conveniences and opportunities that you have?  I hope you are grateful to be alive, but you can counter that the general anxiety level of teens has never been higher since it started getting measured in the 1950s.  In the year 2000, studies involving 10 of thousands of students found “that anxiety has increased so much that typical schoolchildren during the 1980’s reported more anxiety than child psychiatric patients did during the 1950’s.”  “And anxiety has been increasing. The average high school kid today has the same level of anxiety as the average psychiatric patient in the early 1950’s. We are getting more anxious every decade.”

Depression has also increased over this period of history.  Some of the reasons may be a decrease in “social connectedness”—we tend to move more, change jobs, participate less in civic organizations, volunteer and we are less likely to participate in religious communities (churches).  And our expectations have changed in the last fifty years. We expect to have a more affluent life-style, we are driven by unrealistic ideas of what we need (“I need the latest iPod!!”), and we have unrealistic ideas about relationships and appearance. All of these factors can contribute to worry, uncertainty, anxiety and depression.  As notes in part 1 of this series, an anxiety disorder differs from normal anxiety in that it is more severe, it is long lasting and it interferes with studies, activities, family and social relationships.

Risk Factors for Anxiety Disorders

People most at risk are those who:

• ~Have a more sensitive emotional nature and who tend to see the world as threatening

• ~Have a history of anxiety in childhood, including marked shyness

• ~Are female

• ~Experience a traumatic event

Some family factors that increase risk:

• ~A difficult childhood (e.g., experiencing physical, emotional, or sexual abuse; neglect; or overstrictness)

• ~A family background that involves poverty or a lack of job skills

• ~A family history of anxiety disorders

• ~Parental alcohol problems

• ~Parental separation and divorce

Anxiety symptoms can also result from

• ~Some medical conditions, such as hyperthyroidism, arrhythmias, and vitamin B12 deficiency

• ~Side effects of certain medications, including those used to treat ADHD

• ~Intoxication with alcohol, amphetamines, caffeine, cocaine, hallucinogens, and inhalants

Historical trauma:  the cumulative emotional and psychological wounding, during the lifespan and across generations, originating from massive group trauma experiences-has also been linked to anxiety disorders.  Historical trauma poses an added burden for groups that have experienced persecution, for example, American Indian / Alaska Native families, African American families, and refugee families

Sources:

• ~Article: “The Age of Anxiety? Birth Cohort Change in Anxiety and Neuroticism, 1952-1993,” Jean M. Twenge, PhD, Case Western Reserve University; Journal of Personality and Social Psychology, Vol. 79, No. 6.

• ~How Big a Problem Is Anxiety? Accessed from https://www.psychologytoday.com/us/blog/anxiety-files/200804/how-big-problem-is-anxiety

• ~Mental Health First Aid USA 2016 National Council for Behavioral Health

Anxiety #4 of 6

Generalized Anxiety Disorder Overall feelings of anxiety and worry throughout the day in a variety of situations. These thoughts and feelings create a cycle of constant and uncontrollable anxiety, worry and fear. Do you: 

• Feel overly and uncontrollably worried

• Become easily tired, fatigued, irritable or unable to concentrate

• Constantly feel stuck, worthless, or depressed

• Have these feelings/actions caused impairment in your daily life?

Click here for a Generalized Anxiety Disorder Screening

Panic Disorder

Unplanned, unexpected and fearful panic attacks that can occur both situationally or out of nowhere. Do you:

• Find yourself  suddenly intensely but unknowingly fearful and begin sweating, shaking, unable to breath, feeling dizzy and/or numb

• Begin avoiding certain people or places for fear of another attack   

• Constantly feel stuck, worthless, or depressed

• Have these feelings/actions caused impairment in your daily life?

Click here for a Panic Disorder Screening

Social Anxiety Disorder

Fear and avoidance of social situations in which the individual perceives the possibility of being judged or criticized. Do you:

• Fear being judged or noticed in social situations in an unreasonable way

• Find yourself  suddenly intensely but unknowingly fearful and begin sweating, shaking, unable to breath, feeling dizzy and/or numb

• Begin avoiding certain people or places for fear of another attack   

• Constantly feel stuck, worthless, or depressed

• Have these feelings/actions caused impairment in your daily life?

Click here for a Social Anxiety Disorder

Post Traumatic Stress Disorder

For an individual who has been exposed/or been closely involved with someone exposed to actual or threatened death, PTSD invades a person’s thoughts and security in a way that could create a heightened state vigilance, a confusion of actual reality, and isolation. Have you:

• Been involved in any way in a life threatening event

• Re-experienced that event in ways that it feels that its happening again or has caused strong pain and anxiety

• Avoided, detached or erased all situations related to the event

• Been unable to sleep or irritable   

• Have these feelings/actions caused impairment in your daily life?

Click here for a Post Traumatic Stress Disorder Screening

Obsessive Compulsive Disorder

Continuous or recurrent thoughts (obsessions) or behaviors (compulsions) that an individual uses to replace feelings of fear and anxiety. Obsessions and compulsions can include repetitive handwashing, constant need for order, and can sometimes manifest themselves as having specific “tics.” Do you:

• Overly worry about certain thoughts, actions, or events  

• Feel constantly fearful in the absence of a repeated thought or action   

• Constantly feel stuck, worthless, or depressed

• Have these feelings/actions caused impairment in your daily life?

Click here for a Obsessive Compulsive Disorder Screening

Specific Phobia

A strong fear and anxiety that coincides with the actual presence of a triggered situation or object. Specific phobias can include fear of flying, certain animals, or needles. Do you:

• Find yourself afraid in moments where you feel helpless or unable to leave that leaves you breathless

• Have a continuous fear of blood, heights, flying…

• Have these feelings/actions caused impairment in your daily life?

Click here for a Specific Phobias Screening

Agoraphobia

When the fear of being placed in social situations is so extreme, some individuals become agoraphobic-meaning one has become extremely fearful and unsafe around groups of people. Do you:

• Find yourself fearful in any situation involving crowds or social situations in which you feel sweaty, shaky, breathless

• Avoid leaving your home or specific places for fear of something bad happening if you do.

• Have these feelings/actions caused impairment in your daily life?

Click here for an Agoraphobia Screening

Anxiety #5 of 6

Mental Health First Aid Action Plan for Anxiety

ALGEE

1. Action A: Assess for risk of suicide or harm

2. Action L: Listen nonjudgementally (acceptance)

3. Action G: Give reassurance and information (the Quarky app)

4. Action E: Encourage appropriate professional help

5. Action E: Encourage self-help and other support strategies

Action A: Assess for risk of suicide or harm

Crises that may be associated with anxiety are

• The person is at an extreme level of anxiety such as a panic attack.

• The person has experience a traumatic event

• The person has suicidal thoughts or behaviors.

• The person is engaging in nonsuicidal self-injury.

Action L: Listen nonjudgementally

• Talk with the person about how they feel and listen carefully to what they say.

• Do not express any negative judgments about the person’s character or situation.

• Be aware of your body language, including posture, eye contact, and physical position in relation to the person, and adjust it to respect their culture.

• To ensure you understand, reflect back what you hear and ask clarifying questions.

• Allow silences, be patient, do not interrupt, and use only minimal prompts such as “I see” and “Ah.”

• Do not give flippant or unhelpful advice, such as “pull yourself together.”

• Avoid confrontation unless necessary to prevent harmful acts.

Action G: Give reassurance and information

• Treat the person with respect and dignity.

• Do not blame the person for the illness.

• Have realistic expectation of the young person.

• Offer Consistent emotional support and understanding.

• Give the person hope for recovery.

• Provide practical help.

• Offer information.

Action E: Encourage appropriate professional help

Treatments are available that can help many people with anxiety disorders to have a better life.

• Ideally, the professional should have expertise in providing mental health services to youth and young adults.

• Primary care physicians

• Pediatricians

• Nurse Practitioners

• Allied health professionals, such as occupational therapists, youth workers, and mental health nurses.

• Psychiatrists and child and adolescent psychiatrists

• Psychologists and child and adolescent psychologists

• Mental health care providers

• Social workers

Action E: Encourage self-help and other support strategies

Certain factors reduce the risk of developing or worsening anxiety.  Some of these factors include:

• Consistent home or family routine

• Experiencing less stress

• High self-esteem

• Feelings of self-worth

• Feeling in control of one’s life

• Consistent physical activity

• Sufficient social skills

• Secure attachment style

• Economic security

Source: Mental Health First Aid USA 2016 National Council for Behavioral Health