Care & Treatments, Anxiety

17 April, 2018

Anxiety: fight, flight and future-focused fears

We all know what it feels like to be anxious, to be worried about an exam, nervous before a presentation or terrified at the top of a rollercoaster just as it’s about to plummet towards the ground. These are all occasions where it is totally natural to feel a sense of anxiety that soon passes.

There are, however, increasing numbers of individuals reporting levels of anxiety that are disruptive to their day to day lives, often in response to things that may not pose a level of threat to merit the level of anxiety experienced.

In fact, anxiety disorders are the most common mental health difficulties, along with depression, that affect people in Ireland and Europe. It is estimated that 1 in 9 people will suffer a primary anxiety disorder at some stage in their lifetime, but only a fraction of these people will receive the appropriate treatment to manage their condition. This is particularly stark given that research consistently demonstrates that, with expert therapy, the majority of people can achieve a lasting improvement.

Clinical nurse specialist on the Anxiety Disorders programme at St Patrick’s Mental Health Services, Frank Smith, shares his expertise on how anxiety can affect us, what conditions are classed as anxiety disorders and what treatments are available.

What is anxiety?

Anxiety is our body’s response to a perceived threat. When we see, hear or smell something we consider dangerous to us in some way, our brain and our body respond, essentially getting us ready for fight or flight i.e. to fight off danger, or to run away from it. Emotional, cognitive and physical changes all happen to prepare us.

One of the key things about anxiety is that it’s the response to a perceived threat, and what we perceive as a threat may not always be an actual threat. An example that illustrates this is the feeling where we’re in the cinema watching a scary movie through our fingers, terrified by events as they’re unfolding before us. There is nothing actually threatening about that scenario, but the story, music and techniques used by the director make us perceive a threat, thereby activating our anxiety response.

Anxiety – on some level – is part of everyday life and can even be beneficial. How do we know when it’s getting to a level where something more serious is happening?

Anxiety is very important, it keeps us safe from threat. It can start to become a problem when our anxiety response gets triggered by things that aren’t as dangerous as we perceive them to be. Equally when our anxiety starts to cause us significant distress or disruption to our everyday lives, this is an indication that it’s becoming a problem.

Most anxiety disorders have their roots in ordinary things that everyone can feel anxious about, but the anxiety becomes amplified and as a result is majorly disruptive. People often wonder “did I lock the front door” after they’ve gone out for the evening. That can be an uncomfortable thought to sit with, but we can often put it out of mind and get on with the evening. For someone living with OCD, they might think that same thought, but drive back 30 miles to check the door, maybe even doing that multiple times just to be sure.

What are some of the conditions that exist under the umbrella of anxiety disorders?

  • OCD (Obsessive Compulsive Disorder) is characterised by obsessions which are unwanted, intrusive thoughts. These thoughts could be about anything from contamination, to intrusive thoughts about harm. They are thoughts that can pop in and out of most people’s heads on occasion, but for people with OCD, they can get very anxious thinking that they may act on these thoughts or that these thoughts mean that they’re in danger. People with OCD then tend to engage in compulsions which are behaviours intended to neutralise these fears.
  • Social Anxiety Disorder is, broadly speaking, a fear of negative judgement by others. Some people may be fine chatting to people but become very anxious in a one to one job interview setting for example. Other people might be fine dealing with people in work but really struggle to cope in a casual social interaction. People with social anxiety often fear that they’re coming across as weird or boring, they might worry about going red, sweating or clamming up. In many cases people will avoid social interactions or rehearse what they might say in certain circumstances in a bid to reduce their anxiety.
  • Panic disorder is a fear of emotional or physical symptoms of anxiety and so is almost ‘anxiety about anxiety’. People with this condition might, for example, notice that their heart is starting to race, this might lead to a thought that if they can’t slow their heart, they may have a heart attack. Such a thought will in turn trigger their anxiety response – fight or flight – which will make their heart beat faster, thereby leading to catastrophic thoughts such as “I’m going to have a heart attack, I’m going to die”.
  • Generalised anxiety disorder can be characterised be a range of different anxieties and people with this condition might be classed as ‘worriers’, tending to see a threat in a lot of different areas. Someone with generalised anxiety disorder might plan excessively around a holiday for example, worrying about things in order to account for every possible negative outcome. The vast majority of these things are hypotheticals and will never happen, but the individual will have expended the nervous energy worrying about them all the same.

Other anxiety disorders include; agoraphobia, specific phobias (e.g. heights, spiders) and post-traumatic stress disorder.

What treatments are available for anxiety disorders?

The main talking-therapy, and gold standard treatment for anxiety disorders, is Cognitive Behavioural Therapy (CBT), essentially trying to rewire how we think about the things that cause us to feel threatened. It’s those thoughts that tend to cause most of the problems for people living with anxiety disorders and the CBT model provides us with a few different ways of working that help us to challenge those thoughts.

What might an example of CBT in action look like?

If I’m afraid of dogs and I come out of the house in the morning and see my neighbour’s dog there, my anxiety will go up and I’ll think “oh no, he might bite me”, so I might cross the road to avoid him. That may allow me to get on with my day, I won’t feel anxious because I’m away from the perceived threat, but the idea that the dog is going to bite me is going to stay rooted in place.

In this instance we might challenge the thought through some exposure work. Rather than crossing the road, the CBT therapist would encourage me to walk past the dog, take the risk. Obviously, my anxiety will go up, but when I inevitably make it past the gentle dog without being bitten, that’s one less thing for my anxiety to hold on to.

Exposure work is a mainstay of treating anxiety disorders and it’s about giving ourselves the chance to learn that the things we’re afraid of aren’t perhaps as dangerous as we think they are. Unfortunately to do that, we need to go into the situation that’s causing us our anxiety and we need to be in there to learn that.

Is treatment successful for people living with anxiety disorders?

Yes. People will often still be anxious about the things they were anxious about before but will be usually far more able to deal with them and tolerate them in a day to day setting. We try to equip people with the techniques that get them to a place where they can be their own therapist as it were, continuing to do the exposure work and continuing to benefit from it.

If you, or someone you know, might be living with an anxiety disorder, you can contact the St Patrick’s Support & Information Line, staffed by experienced mental health nurses on (01) 249 3333 or email

Tags:   OCD   Anxiety   Social Anxiety Disorder   Panic disorder   Generalised anxiety disorder   CBT   Treatment