By Kenneth Lim with inputs from Circle-of-Care
Anxiety is the body’s natural response to danger. It acts as an automatic alarm that goes off when you feel threatened, pressured or stressed. In moderation, anxiety isn’t always a bad thing. In fact, a healthy level of anxiety can help you to stay alert, focused and motivate you to action.
But when anxiety is constant or overwhelming, and when it interferes with your relationships and daily routine, it starts becoming a cause for concern because it crosses the line from productive anxiety into the territory of anxiety disorders.
Under the broad umbrella of ‘Anxiety’, there are six types of disorders. Each has its own presenting concerns and repercussions as well as underlying symptoms:
Generalized Anxiety Disorder – Excessive and unreasonable worrying that affects the patient’s rationality and general functionality. This takes a toll on their physical health as they might suffer from restlessness, loss of sleep and muscle tension, depending on the level of severity.
Panic Disorder – Patients suffer from recurrent panic attacks which are episodes of intense and crippling fear that trigger several physical reactions. Almost half of the victims of this disorder suffer from Agoraphobia – having an irrational fear of public spaces or open areas. Victims might experience dizziness, loss of self-control and other symptoms that resemble a heart-attack, and this could last from minutes to hours, depending on the severity.
Specific Phobia – Victims of this disorder suffer from excessive and unreasonable fear of specific objects/situations (E.g.: Heights, Animals, sight of blood etc). Exposure to the feared object/situation will trigger an anxiety response. If serious, daily functioning could be compromised.
Social Anxiety Disorder – This is classified as an excessive and unreasonable fear of social situations. People who suffer from this disorder fear that they would be evaluated or judged negatively by others. Therefore, being in situations that involve public speaking and interaction with strangers take a toll on the victim’s physical and mental state.
Obsessive-Compulsive Disorder – Characterized by recurrent obsessions, compulsions or both, which interfere with a person’s usual functioning. Obsessions vary from health concerns all the way to religious preoccupations which might give rise to compulsive behavior such as excessive washing, checking, repeating, counting, hoarding and more.
How to identify if someone is suffering from anxiety disorders?
The most straightforward sign when a person is suffering from anxiety issues would be their excessive, incessant fear and worry about things in everyday life. Apart from that, patients also show feelings of apprehension, restlessness, irritability, pessimism and might blank out at times.
Stress on the mind often causes bodily reactions as well, causing people to mistake symptoms of this disorder as an everyday medical illness. Physical symptoms include increased heart-rate, sweating, dizziness, stomach upsets, shortness of breath, muscle tension, tremors, shivering, headaches and insomnia.
It is important to learn and advocate basic identification skills so as to prevent self-diagnosis and time-wastage at improper avenues of help.
Prevalence of anxiety among youth in Singapore
According to the latest statistics from the Singapore Mental Health Study (SMHS), almost seven thousand Singapore citizens and PRs (aged 18 and above) were surveyed for the prevalence and demographics of major mental disorders, which includes generalized anxiety disorder and obsessive-compulsive disorder under the anxiety umbrella.
The results from the above study showed that younger people in Singapore made up higher proportions of people suffering from generalized anxiety disorder.
This phenomenon could be attributed to high levels of stress, long working hours and poor coping resources due to age and maturity.
Anxiety disorders also affect those from minor ethnic groups more severely than others. One reason for this happening could be because those from minor ethnicities have more difficulty adapting to the majority culture and are more vulnerable to social stigma.
Another surprising fact is that anxiety disorders are more prevalent in individuals with higher education qualifications, such as degree-holders, college graduates and diploma holders.
Higher rates of anxiety in this group of individuals could probably stem from a heavier societal burden of expectations on their shoulders and varying perceptions regarding quality of life and reality not matching up to the individual’s expectations.
Lastly, according to the study, being unemployed led to a greater tendency to suffer from anxiety disorders.
Healing and Recovery
The recovery process for anxiety disorders is subjective. For some, it might just be a short while and for others, it can be a long and arduous journey that might last a lifetime. Recovery depends on various factors such as social support, self-determination and resonance to various therapies.
Cognitive Behavioral and Exposure Therapy
Cognitive Behavioral Therapy (CBT) and Exposure Therapy are considered the most effective treatments for anxiety disorders. Typically, treatments consist of 8-16 one-hour sessions before discontinuation, and there is usually marked and visible improvement in the patient’s condition.
CBT incorporates a number of techniques and skills to challenge a patient’s excessive and irrational beliefs on various aspects of their disorder/phobia. By doing so, it attempts to reduce non-logical emotions by inducing rational thinking. Exposure Therapy is a subset of CBT, where patients are progressively put in controlled situations where they have to confront their fears/phobia. Anxiety will naturally and gradually decrease after multiple sessions, and patients will then move on to confront more difficult anxiety-producing objects or situations.
Emotional Freedom Technique
The Emotional Freedom Technique is a psychological acupressure technique that can be used for healing purposes from anxiety. This technique involves the verbalization of empowering and positive affirmations, while tapping on various psychological acupressure points, based on the same points used in traditional acupuncture. Usually, patients feel more relaxed after this short procedure which lasts a few minutes.
Basic meditation is one of the easiest skills to learn – many people think that one has to take many classes and devote a lot of time to properly learn meditation, but that is not true. In essence, basic meditation involves two simple components.
The first would be deep and mindful breathing. In this very hurried and fast-paced society, we rarely get the time to just quieten down, close our eyes and take deep breaths to calm our bodies.
The second component would be to address our thoughts during this deep breathing process. During this process, we do not judge our thoughts, but we acknowledge and accept them as they come.
Read on to learn how two young people found their unique approaches to battle anxiety.
The mental health scene in Singapore is working on closing the treatment gaps of anxiety-related disorders such as Generalized Anxiety Disorder and Obsessive-Compulsive Disorder, which are at 56.5% and 89.8% respectively. Treatment gap refers to the percentage of people actively suffering from the disorder but not undergoing treatment/receiving inadequate treatment.
You can also turn to online resources such as Circle of Care (http://coc.overtherainbow.sg) and reachforstudents.com for support and guidance during your recovery journey. Do not hesitate to seek professional help if you feel you need it.
Nora*, 19, tells Khanh Tran how she deals with anxiety.
“The chemical changes in your brain create a tendency for it to get used to depression and anxiety. Do not give in. Try. Even if your goal for the day is to get out of bed, it is still a step towards recovery”.
Q: What are your symptoms?
A: For me, when I experience an anxiety episode, I am very nauseous. There's a choked feeling in my throat. I am unable to sleep. I start to feel guilty and depressed. When I experience a panic attack, I go into a ‘dreamlike state’. It feels like, well, in a dream where I can put myself in dangerous situations and not have anything happen to me. Oh, by the way, my anxiety is related to social situations (social anxiety) and also perfectionism.
This year there was an occasion where I had to present in front of a room of sixty people. Throughout the presentation I was in a dreamlike state. I had already memorized my script so I said everything perfectly, but near the end of the presentation I hyperventilated and was sent to the hospital. The ‘throbbing feeling’ in my chest made me feel like my heart was going to explode and that I was going to die.
Q: Usually, what are the triggers that cause your anxiety?
A: When it was quite bad, during the first two years, it was social situations. Being around more than ten people I didn't know, going to church, answering a question in class (I would rather stay silent when asked), presenting in front of anyone (even if it's just one person), walking down a street full of stationary cars, knowing that there's group projects the next day. Before I entered university, I looked for a speech coach to help me practice. I knew that we would have to introduce ourselves during orientation. It took me three weeks to present this to my coach: “Hi my name is Nora. I like XXX, XXX, and doing XXX** in my free time”.
Q: Did you seek professional help?
A: Yes I saw a psychologist first and tried CBT (Cognitive Behavioural Therapy). I found it expensive and quite unhelpful even though it's supposedly one of the best methods to help with depression and anxiety.
Additionally, my close ones expected it to work like an instant miracle. After just two sessions, they began asking ‘how wasn't I better already’? Eventually I got discouraged and stopped seeing the psychologist after eleven sessions.
I went on to talk to counsellors, but was betrayed by one of them despite having been promised confidentiality. At that time, my depression and anxiety were pretty bad, so this event affected me a lot as well.
It's different for everyone, but I found it cathartic to talk to someone. Counsellors are trained to help you sort out your thoughts and help you discover what the root of the problem is. But I also found that talking did not lead to active action that would actually help me.
So in early 2014, following suicidal thoughts, I saw a psychiatrist which I found helped me the most. He asked me many questions, but did not seem to provide answers. He provided medication as well, which had many sideline ramifications, like causing additional suicidal thoughts, apathy and fatigue.
These medications were not ‘miracle pills’; I only felt their effects after six months. During this time, I discussed with my psychiatrist the other ways I could help myself: through exercise, diet change, volunteer work and increment in social life.
Ultimately, I find that professional help tells you what is wrong and how you can help yourself. The rest is up to the determination and resilience of the person. Also, other factors like the availability of social support help propel the process.
Q: What did you do to help yourself?
A: It was a complex combination of many things. I read a lot of self-help books and implemented those ideas. Today, I exercise daily, avoid trigger foods such as caffeine, take Omega-3 vitamin capsules, maintain a balanced social life and make sure I get sufficient sunlight.
There's no prescribed solution for depression or anxiety. I believe you have to try many things and keep choosing recovery.
The medication, exercise and change in diet helped me feel slightly better. From there, I went on to do what I term ‘exposure therapy’, which is basically locking myself in situations that I'm anxious about. For example, I signed up for three jobs related to customer service while I was out of school. My first job was as an interviewer. I remember the first time I picked up the phone to dial a customer in the office. I had memorized a script, but I cried the whole way through as I asked the customer the stipulated questions. The second and third call weren't easy either. But I persisted, mainly because there would be monetary consequences if I quit. By the end of the month, I was able to approach and conduct a face-to-face interview with a complete stranger.
Q: How about for other people? What would you prefer those around you to do?
A: I would greatly appreciate it if my close ones could be more empathetic. I think it is important that if someone has a close one suffering from mental illness, to find out as much as that illness as possible.
If you don't know, ask questions, and do not assume. Then you are already being a great help. Social support from friends and family is important. But I can't expect everyone to understand what I'm going through -- attempting to relate to me is enough. In the end, it's up to only me to pull myself from the abyss.
* Name changed
** The interviewee did not want to reveal their hobbies and preferences.
Yohanna Abdullah shares with us how her organization Club Heal helped Eza on the road to recovery.
Eza, 34, has been a full-time taxi driver for eight months. There may be nothing extraordinary in that if not for the fact that she suffers from depression and anxiety disorder. She was diagnosed to have this condition and panic attacks in 2011 after five months of seeing various bomoh or shamans and religious leaders.
Shamans and Satan
“Ironically it was a bomoh who had tried to treat me without success who asked me to consult a doctor at Bukit Batok. I think she was fed up of seeing me. The doctor told me that I was mentally not stable and that my condition is not about spirits in my body. I did not take his medication because I refused to believe the diagnosis until I was driven to contemplating suicide. I wanted to jump off a building and I was already hearing all kinds of voices in my head”, says Eza.
Again she approached a bomoh but was told that Satan was inside her and would not go out of her body. Her condition deteriorated as she saw more shamans who asked her to take floral baths, lime baths and wear amulets around her neck and waist. As her anxiety escalated, she felt compelled to see a doctor and took a step further to seek help at Club HEAL.
Medication is the key
“At Club HEAL, I was encouraged to take my medicine and I felt the change fairly quickly. My mum who was not inclined to accept Western medication for my condition was convinced that it worked when she saw the changes in me after complying with my treatment”, observes Eza.
“After one a half years at Club HEAL I felt I was ready to leave and spread my wings and find a job. I worked at KFC. I broke down a few times at KFC but they treated me well. I can drive and I felt the urge to be a taxi driver and applied for a licence to be one”, she adds.
Being a taxi driver in real life took guts and confidence. Initially, Eza got into minor road accidents because of her anxiety. “It would be just a minor scrape, but I would cry like it was a major calamity and everyone would look puzzled”.
“I still have my symptoms but now I know that it is just an illness and after a while the symptoms will go away. Initially when I started to drive a taxi, I had panic attacks. The symptoms made me feel as if I was going to die, but I do a lot of positive self-talk. I would remember what I learned at Club HEAL and I would go to mosques to endear myself to God. I also do charity every day, with my sincere intention to help others, even if it is just a donation of 10 cents. I believe all this helps”, says Eza.
One day at a time
A mother of one and married to an understanding husband, Eza counts herself fortunate to make a livelihood driving a taxi full time. “I have the support of my mother who still cooks and cleans and look after my son. Considering this, I am very lucky. But my mom is tired and tells me I have to do more at home and take over her chores”.
However, she takes her challenges one day at a time as she learns to be more positive about life. One thing is for sure, she believes there is a cure to every illness and that she is on the road to recovery. “Faith is the key and every day, I am getting better and better”, says Eza.