“Ask Dr. HKSH” - Coping with Anxiety

Dr. LIAO Wei Ming, Carmen

Specialist in Psychiatry

Q1. What is anxiety? What are the common symptoms?

Anxiety is one of our basic emotions. It is triggered by fear and worry about uncertainties and helps us respond properly to potential threats. There are three aspects of anxiety: physiological, psychological, and behavioural. Physiologically, anxiety may cause many somatic symptoms and cause general discomfort eg palpitations, tachycardia, shortness of breath, chest tightness, a choking sensation, dizziness, headache, numbness, sweating, abdominal pain, nausea, insomnia, etc. The psychological aspect includes feeling anxious, chaotic thoughts, mind blanking, or catastrophic thoughts. Behaviour-wise, one may become restlessness, fidget with hands and avoid anxiety-provoking situations.

Q2. How to manage anxiety emotions? When should one seek medical help?

There are different ways to manage anxiety. We can learn mindfulness which focus on the present and pay attention to our emotions and thoughts. At the same time, observe the breathing patterns and draw slow, deep breaths, as it can activate the parasympathetic nervous system and help us relax. We can also observe the state of our muscles and practise progressive muscle relaxation; if certain muscles are tensed, try to relax them gradually. In addition, regular aerobic exercise such as yoga, jogging or swimming can release brain endorphins, a natural “anti-anxiety” agent, and help us relax. If the above methods fail, you may consider medications and consult a doctor for prescription to control symptoms. 

Q3. I often feel anxious. Do I have an anxiety disorder?

Feeling anxious is normal and even necessary, as it help us to cope with crises. However, if it gets too strong and prolonged affecting work, life and social relationships, it may indicate an anxiety disorder.

Q4. Why did I suddenly develop an anxiety disorder?

The causes of anxiety disorders are complex and multifactorial. They may be influenced by family history, genetic factors, personality traits, and environmental stressors in life. Some people may have a genetic predisposition that increases brain (amygdala) reactivity and causes  imbalance in brain neurotransmitters. Those who are perfectionist or lacking in confidence are especially vulnerable. When stress level exceeds coping capacity, an anxiety disorder may result.

Q5. Are there different types of anxiety disorders?

Common anxiety disorders include panic disorder, obsessive-compulsive disorder (OCD), generalised anxiety disorder (GAD) and specific phobia, which includes separation anxiety, agoraphobia, social phobia, etc.

Q6. What is panic disorder?

It is a very common type of anxiety disorder. Panic disorder may come unprovoked even at rest. It comes with palpitations, chest heaviness, breathing difficulties, a sensation of suffocation, limb numbness or tingling sensation, abdominal pain, nausea, sweating, a choking sensation, dizziness, etc. Patients often feel they are “about to die” or “losing control”. A typical attack lasts from 10 to 20 minutes. Patients will be worried about the next attack even after symptoms subside.

Q7. What can I do at the onset of panic attack?

If you just have your first panic attack, please go for a full physical check-up to rule out thyroid problems or other heart conditions. When the attack is imminent or already happening, try to breathe in and out of a paper bag. Try also to feel the up and down movement of abdomen while breathing slowly. It can activate the parasympathetic nervous system and help to relieve anxiety. Slowly count “one, two, three, four” while breathing gently through the nose. Then hold two seconds and slowly breathe out while counting “one, two, three, four, five, six”. 

Remind yourself repeatedly: “This is just a false alarm from my body; there is no real danger, and this feeling will soon be over.” Try to observe and accept this feeling instead of fighting it —struggling may make it worse. If the above techniques do not work, we may consider medications.

Q8. Is anxiety disorder incurable?

Anxiety disorder is not incurable. After proper treatment, most patients can learn to manage their anxiety and stress effectively. Although there is a chance of relapse, once they master these skills, both the intensity and frequency of episodes will decrease significantly. Recovery is a journey, but not an end.

Q9. My loved one might have an anxiety disorder but refuses treatment. How can I help?

A trusting relationship is needed before we can help. If your loved one resists treatment, the most important thing is to choose a suitable place and time to start a conversation when he/she is relatively stable.  Avoid lecturing or judgmental remarks such as “You’re thinking too much”. You may express your observations and concerns gently by telling them “I’ve noticed lately that you look tense and worried, and I feel concerned about you.” Remember to validate his/her feelings and emotions, and acknowledge his/her difficulties. Always respect his/her privacy and the current decision not to seek help. At the same time, take care of your own mental well-being—it is not your duty to “cure” them. Do not exhaust yourself.