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Anxiety Symptoms That Many People Overlook

Anxiety Symptoms That Many People Overlook

“Anxious” is a word with two faces. Sometimes it means eager excitement. “I’m anxious to see you!” we say, as we get off the phone with a friend who’s coming to visit. The other side of “anxious” is a bit darker: “I’m anxious about that test,” we say, when we’re worried about the results. We call the second meaning “anxiety,” and most of us experience it from time to time.

In common usage, both meanings of “anxious” describe our responses to fleeting, time-limited events. But anxiety can also have a much more powerful grip on many of us. Without the right kind of attention, it can rule our lives.

I’m a psychotherapist in private practice north of Boston, Massachusetts, and I’ve worked with many clients who have anxiety. In this, the first of two articles on a psychotherapist’s views on anxiety, I’ll describe what anxiety is and how you can tell whether you or someone close to you is suffering from it. In Part II, I’ll go into its causes and treatments, as well as the best ways to help heal from anxiety disorders.

Anxiety is more common than people think

More people in the United States have anxiety disorders than any other mental illness. Anxiety affects more than 40 million adult Americans and about one in eight children. Some experts put the estimate much higher, because many people don’t know they have anxiety, are diagnosed incorrectly, or don’t seek help for it.

In my psychotherapy practice, nearly all my clients have some form of anxiety. Sometimes it’s the main reason they came to therapy, and sometimes it’s an underlying issue that shows up after we’ve handled the immediate reason they came for help.

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Only about one-third of people who have anxiety disorders seek treatment.

Many anxious people know they have anxiety, but many more do not. They think catastrophizing, expecting the worst, worrying about what people think of them, or staying up late at night worrying about just about everything is normal.

It feels normal because that’s what they’ve been used to most of their lives – but it doesn’t have to be. Most people with an anxiety disorder can overcome it with treatment, support, and self-help strategies.

The difference between feeling worried and having anxiety

An anxiety disorder is different from feeling worried or being afraid. Worries about new or uncertain situations are normal, and feeling afraid in potentially dangerous situations is not only normal, but can sometimes save your life. Worrying about how you will perform on an exam might motivate you to study harder. Worrying about an erratic driver in front of you might help you drive more defensively. Feeling fearful about driving on a winding road in a storm might get you to wait for safer weather conditions.

Also, not everybody who worries a lot has an anxiety disorder. You might feel anxious because of too much work, too much stress, too little sleep, too much coffee, or low blood sugar.

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The biggest distinction between normal worry or fear and anxiety disorders is that anxiety disorders involve some form of chronic anxiety, and the anxiety interferes with normal functioning.

7 specific anxiety disorders

There are several kinds of anxiety disorders, and they each look and feel different from one another. One person might have intense panic, another might avoid social situations, another might be unreasonably frightened by dogs, and someone else might worry about nearly everything.

All anxiety disorders share a persistent fear or worry in situations where most people would not be afraid. Specific anxiety disorders have other, specific symptoms.

1. Social Phobia

People with social phobias are afraid of embarrassment or judgement in social situations and may blush, feel tongue-tied, go blank, have rapid heart rate, or show other signs of anxiety in those situations. They will avoid social situations whenever possible.

2. Special Phobias

People with special phobias might be unreasonably afraid of animals such as dogs or spiders, natural events like storms or lightning, heights, open spaces, enclosed spaces, and other parts of the normal world. They may go to extremes to avoid these things.

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3. Generalized Anxiety Disorder

Symptoms of Generalized Anxiety Disorder (GAD) can include feeling nervous most of the time, a sense of impending doom, feeling helpless, rapid breathing, increased heart rate, sweating, trembling, a queasy feeling, and tension in the neck, shoulders, or both.

4. Acute Stress Disorder and Post-Traumatic Stress Disorder (PTSD)

Both of these anxiety disorders sometimes occur after people have witnessed or experienced a physical threat. Symptoms include disturbing memories, flashbacks of the event, trouble sleeping or concentrating, and feeling either tense or numb. Acute Stress Disorder symptoms begin within a month of the traumatic event, while PTSD symptoms typically begin later. Symptoms can last for many years without treatment.

5. Panic Disorder

People with panic disorder have unexpected, severe anxiety attacks during which they are afraid they might die, pass out, or that they are suffocating. They often avoid places where panic attacks occur, which can lead to agoraphobia.

6. Hypochondria

People with hypochondria (now called Illness Anxiety Disorder) worry about having illnesses they probably don’t have. They catastrophize minor or imagined symptoms into a worst-case scenario. For example, they may be convinced that a headache means they have a fatal brain tumor.

7. Obsessive-Compulsive Disorder (OCD)

Sufferers may check obsessively, count when counting is unnecessary, and in general do ritualized behaviors. They feel unbearably anxious if they do not perform these rituals.

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The most common anxiety disorders, in approximately this order, are: Social Phobia, Specific Phobias, Generalized Anxiety Disorder, Acute and Post-Traumatic Stress Disorders, Panic Disorder, Hypochondria, and Obsessive-Compulsive Disorder

In my practice, I most often encounter Generalized Anxiety Disorder and PTSD, though I have also had many clients with Panic Disorder, Hypochondria, Social Anxiety Disorder, and Obsessive-Compulsive Disorder. Sometimes, people come in with more than one anxiety disorder. Hypochondria and Generalized Anxiety Disorder, for example, often show up in the same person, as do Social Anxiety Disorder and perfectionism which, though not an “official” anxiety disorder, contributes greatly to most forms of anxiety.

Signs of anxiety disorders

If you identify with any of the following symptoms, you might be dealing with an anxiety disorder.

  • You’re almost always worried or on edge.
  • You have irrational fears that you just can’t shake.
  • You’re often afraid that bad things will happen if you don’t do things in a particular way.
  • You avoid everyday situations or activities because they make you anxious.
  • You have sudden, unpredictable attacks of heart-pounding panic.
  • You almost always expect the worst.
  • You have trouble getting to sleep or staying asleep.
  • Your muscles almost always feel tense.
  • You often feel overwhelmed.
  • You expect more from yourself than most people do
  • You tend to focus on your health and personal problems more than other things in your life.
  • Your anxiety interferes with work, school, or family life.
  • You have one or more of the following physical symptoms: pounding heart, sweating when you’re not exercising or in a warm place, headaches, frequent upset stomach or diarrhea, dizziness, shortness of breath, shaking or trembling.

Some anxiety disorders are harder to spot

In my experience with psychotherapy clients, PTSD is usually the most difficult to spot because its symptoms don’t always cleanly match the standard definition. PTSD can look like depression, several other forms of anxiety disorder, ADHD, or a combination of mental illnesses.

An example: I once worked with a client who seemed to cycle through several anxiety disorders within a few months. She first displayed typical signs of panic disorder, and we quickly worked through them. But then OCD symptoms appeared. Again, we worked through them in what seemed like record time. Irrational fears and intrusive, disturbing thoughts soon followed.

It was a few months before we understood that what she was actually suffering from was the aftermath of childhood trauma. She had what I now think of as free-floating anxiety – a form of anxiety that unconsciously attaches itself to other anxiety syndromes. A clue to understanding how to help her was that she had majored in psychology and knew about various mental illnesses. Her half-remembered knowledge of common anxiety disorders gave her free-floating anxiety a place to focus. Working through the trauma helped her resolve all her anxiety symptoms.

Stay tuned!

In this article, we’ve looked at how worrying and fear are different from anxiety disorders and have identified the main symptoms of common anxiety disorders. In Part II of this two-part series, we’ll go into the causes of anxiety disorders, their treatments, and some self-help practices people with anxiety disorders and their loved ones can do.

More by this author

David J. Bookbinder, LMHC

Psychotherapist, writer, and photographer north of Boston, MA.

Anxiety Symptoms That Many People Overlook The Best Anxiety Treatment I’d Recommend as a Psychotherapist

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Last Updated on October 30, 2019

How the Stages of Change Model Helps You Change Your Habits

How the Stages of Change Model Helps You Change Your Habits

Change is tough, there’s no doubt about it. Old habits are hard to shift, and adopting a new lifestyle can feel like an uphill battle!

In this article, you will learn about a simple yet powerful model:

Stages of change model, that explains the science behind personal transformation.

You’ll discover how and why some changes stick whereas others don’t last, and how long it takes to build new habits.

What is the Stages of Change Model?

Developed by researchers J.O. Prochaska and Carlo C. DiClemente over 30 years ago[1] and outlined in their book Changing For Good, the Stages of Change Model, also known as the Transtheoretical Model, was formed as a result of the authors’ research with smokers.

Prochaska and DiClemente were originally interested in the question of why some smokers were able to quit on their own, whereas others required professional help. Their key conclusion was that smokers (or anyone else with a bad habit) quits only when they are ready to do so.

Here’s an illustration done by cartoonist and illustrator Simon Kneebone about the different stages a smoker experiences when they try to quit smoking:

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    The Stages of Change Model looks at how these conscious decisions are made. It emphasizes that change isn’t easy. People can spend a long time stuck in a stage, and some may never reach their goals.[2]

    The model has been applied in the treatment of smoking, alcoholism, and drugs. It is also a useful way of thinking about any bad habit. Social workers, therapists, and psychologists draw on the model to understand their patients’ behaviors, and to explain the change process to the patients themselves.

    The key advantages to the model is that it is simple to understand, is backed by extensive research, and can be applied in many situations.

    The Stages of Change Model is a well-established psychological model that outlines six stages of personal change:

    1. Precontemplation
    2. Contemplation
    3. Determination
    4. Action
    5. Maintenance
    6. Termination

    How are these stages relevant to changing habits?

    To help you visualize the stages of change and how each progresses to the next one, please take a look at this wheel:[3]

      Let’s look at the six stages of change,[4] together with an example that will show you how the model works in practice:

      Stage 1: Precontemplation

      At this stage, an individual does not plan to make any positive changes in the next six months. This may because they are in denial about their problem, feel too overwhelmed to deal with it, or are too discouraged after multiple failed attempts to change.

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      For example, someone may be aware that they need to start exercising, but cannot find the motivation to do so. They might keep thinking about the last time they tried (and failed) to work out regularly. Only when they start to realize the advantages of making a change will they progress to the next stage.

      Stage 2: Contemplation

      At this stage, the individual starts to consider the advantages of changing. They start to acknowledge that altering their habits would probably benefit them, but they spend a lot of time thinking about the downside of doing so. This stage can last for a long time – possibly a year or more.

      You can think of this as the procrastinating stage. For example, an individual begins to seriously consider the benefits of regular exercise, but feels resistant when they think about the time and effort involved. When the person starts putting together a concrete plan for change, they move to the next stage.

      The key to moving from this stage to the next is the transformation of an abstract idea to a belief (e.g. from “Exercise is a good, sensible thing to do” to “I personally value exercise and need to do it.)[5]

      Stage 3: Preparation

      At this point, the person starts to put a plan in place. This stage is brief, lasting a few weeks. For example, they may book a session with a personal trainer and enrol on a nutrition course.

      Someone who drinks to excess may make an appointment with a drug and alcohol counsellor; someone with a tendency to overwork themselves might start planning ways to devise a more realistic schedule.

      Stage 4: Action

      When they have decided on a plan, the individual must then put it into action. This stage typically lasts for several months. In our example, the person would begin attending the gym regularly and overhauling their diet.

      Stage 4 is the stage at which the person’s desire for change becomes noticeable to family and friends. However, in truth, the change process began a long time ago. If someone you know seems to have suddenly changed their habits, it’s probably not so sudden after all! They will have progressed through Stages 1-3 first – you probably just didn’t know about it.

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      Stage 5: Maintenance

      After a few months in the Action stage, the individual will start to think about how they can maintain their changes, and make lifestyle adjustments accordingly. For instance, someone who has adopted the habit of regular workouts and a better diet will be vigilant against old triggers (such as eating junk food during a stressful time at work) and make a conscious decision to protect their new habits.

      Unless someone actively engages with Stage 5, their new habits are liable to come unstuck. Someone who has stuck to their new habits for many months – perhaps a year or longer – may enter Stage 6.

      Maintenance can be challenging because it entails coming up with a new set of habits to lock change in place. For instance, someone who is maintaining their new gym-going habit may have to start improving their budgeting skills in order to continue to afford their gym membership.

      Stage 6: Termination

      Not many people reach this stage, which is characterized by a complete commitment to the new habit and a certainty that they will never go back to their old ways. For example, someone may find it hard to imagine giving up their gym routine, and feel ill at the thought of eating junk food on a regular basis.

      However, for the majority of people, it’s normal to stay in the Maintenance period indefinitely. This is because it takes a long time for a new habit to become so automatic and natural that it sticks forever, with little effort. To use another example, an ex-smoker will often find it hard to resist the temptation to have “just one” cigarette even a year or so after quitting. It can take years for them to truly reach the Termination stage, at which point they are no more likely to smoke than a lifelong non-smoker.

      How long does each stage take?

      You should be aware that some people remain in the same stage for months or even years at a time. Understanding this model will help you be more patient with yourself when making a change. If you try to force yourself to jump from Contemplation to Maintenance, you’ll just end up frustrated. On the other hand, if you take a moment to assess where you are in the change process, you can adapt your approach.

      So if you need to make changes quickly and you are finding it hard to progress to the next stage, it’s probably time to get some professional help or adopt a new approach to forming habits.

      The limitations of this model

      The model is best applied when you decide in advance precisely what you want to achieve, and know exactly how you will measure it (e.g. number of times per week you go to the gym, or number of cigarettes smoked per day). Although the model has proven useful for many people, it does have limitations.

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      Require the ability to set a realistic goal

      For a start, there are no surefire ways of assessing whereabouts in the process you are – you just have to be honest with yourself and use your own judgement. Second, it assumes that you are physically capable of making a change, whereas in fact you might either need to adjust your goals or seek professional help.

      If your goal isn’t realistic, it doesn’t matter whether you follow the stages – you still won’t get results. You need to decide for yourself whether your aims are reasonable.[6]

      Difficult to judge your progress

      The model also assumes that you are able to objectively measure your own successes and failures, which may not always be the case.[7] For instance, let’s suppose that you are trying to get into the habit of counting calories as part of your weight-loss efforts. However, even though you may think that you are recording your intake properly, you might be over or under-estimating.

      Research shows that most people think they are getting enough exercise and eating well, but in actual fact aren’t as healthy as they believe. The model doesn’t take this possibility into account, meaning that you could believe yourself to be in the Action stage yet aren’t seeing results. Therefore, if you are serious about making changes, it may be best to get some expert advice so that you can be sure the changes you are making really will make a positive difference.

      Conclusion

      The Stages Of Change Model can be a wonderful way to understand change in both yourself and others.

      While there’re some limitations in it, the Stages of Change Model helps to visualize how you go through changes so you know what to expect when you’re trying to change a habit or make some great changes in life.

      Start by identifying one of your bad habits. Where are you in the process? What could you do next to move forwards?

      Featured photo credit: Unsplash via unsplash.com

      Reference

      [1] Psych Central: Stages Of Change
      [2] Boston University School Of Public Health: The Transtheoretical Model (Stages Of Change)
      [3] Empowering Change: Stages of Change
      [4] Boston University School Of Public Health: The Transtheoretical Model (Stages Of Change)
      [5] Psychology Today: 5 Steps To Changing Any Behavior
      [6] The Transtheoretical Model: Limitations Of The Transtheoretical Model
      [7] Health Education Research: Transtheoretical Model & Stages Of Change: A Critique

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