Anxiety disorders: An overview
What are they, how many have them, how do we prevent or treat them
Let’s start with the basics, what is anxiety and what are anxiety disorders?
According to the American Psychological Association, anxiety is an emotion characterised by feelings of tension, worried thoughts, and physical changes like increased blood pressure.
However, anxiety is a part of normal life and responses like these to significant events happen all the time. It’s when these feelings become persistent or are triggered by everyday occurrences that this resembles an anxiety disorder more than just an anxious state.
There are several types of anxiety disorders. The mental health charity Mind, suggests a few of the main types, including:
Generalised anxiety disorder (GAD) – regular or uncontrollable worries about many different things in your everyday life.
Social anxiety disorder – experiencing extreme fear or anxiety triggered by social situations (e.g. work, socialising with friends, parties, etc.)
Panic disorder – regular or frequent panic attacks without a clear cause or trigger.
Phobias – extreme fear or anxiety triggered by a particular situation (such as tight spaces) or a particular object (such as insects)
Post-traumatic stress disorder (PTSD) – anxiety problems after going through something you found traumatic.
Statistics from the Mental Health Foundation suggest that over 20% of people in the UK suffer from high feelings of anxiety. That’s a lot of people!
It’s worth noting that this is age dependent. 28% of Adults under the age of 30 reported high anxiety while only 5% of those over 70 reported the same. We’re not sure why this effect exists. It might be that people become less anxious as they age or because the world has become much more anxiety provoking (social media, fake news, climate crisis etc.) and young people are in the thick of it. Monitoring people over time will help to give us the answer.
What causes anxiety disorders?
As we hinted above, anxiety disorders manifest when you are exposed to chronic or severe stressors. People who have experienced childhood trauma, war, long term stress at work, are all more likely to experience anxiety disorders. But this is just a part of the story. It’s not just what happens to us but how we perceive and respond to these events that’s key. One person may find a given situation anxiety provoking while another doesn’t. Several factors have been identified as linked to our anxiety response and therefore linked to whether we develop anxiety disorders.
An important piece of the puzzle are genetics and upbringing which set the stage for how we respond to stressful events. For example, our early years influence how we interpret and respond to events. A core concept in psychology is known as the ‘locus of control’. I.e. where do you think control rests, is it in you or in something external. If you perceive yourself to be in control, then you have more agency and are more likely to respond to negative events in a positive way. Research has shown that a traumatic childhood (bullying, neglect, emotional abuse, etc.) is more likely to leave you with an external locus of control (i.e. you feel less in control of events around you). Similarly, other studies have shown that growing up in anxious households makes children more likely to perceive novel stimuli as threats, triggering an anxiety response. It’s therefore not unsurprising that individuals who have experienced childhood trauma are much more likely to exhibit mental health issues as adults including anxiety.
Lifestyle has also been thought to be a driver with factors like social media use, diet, social support, and exercise also linked. When it comes to social media, a study by researchers at MIT showed that access to Facebook increased anxiety rates by a whopping 20%. There’s a few different mechanisms here one is the ‘always on’ dynamic where people feel beholden to every notification and anxious about leaving people hanging or not catching the latest trend. Another is the ‘social comparison’ dynamic. This is where people compare their lives with their social media feeds. Of course social media feeds are a highly selective view into someone’s life and not a good reference point for social comparison. As every Instagram boyfriend/girlfriend will know, each post requires meticulous planning, staging and dress up to be a hit.
In terms of diet, one huge review looked at over 1,000 studies and found that healthier diets (specifically comprising low fat, high micronutrient content foods with plenty of fruits and vegetables) was associated with lower rates of anxiety, while the opposite diet was linked to increased rates of anxiety. Some of this takes place via the gut microbiome, the trillions of bacteria in our guts that are hard at work delivering all kinds of health benefits for us. We are beginning to understand the changes in the gut microbiome that are related to anxiety. In some cases, certain bacteria might be missing or in short supply, in others, they might be in abundance. These changes are linked to lifestyle more broadly and especially diet as bacteria feed off of the different types of food we eat.
Social support has also been linked to reduced anxiety symptoms. Anyone who’s had friends or family support them through a tough time will know this intuitively but just in case, the Harvard study, the world’s longest study in human happiness indeed found that the strength of relationships is the most important thing for happiness and wellbeing through the different types of support offered.
Finally, modest amounts of exercise have been linked with preventing or reducing anxiety symptoms and given the other health benefits of exercise, this is an important strategy someone can invest in.
Given that many of these lifestyle factors are deteriorating in modern life, it’s no surprise that anxiety disorders are on the rise. In 2018/19, 19.8% of people reported high levels of anxiety but for the year 2021/22, this had jumped to 22.5%. It’s possible that this was driven by the Covid pandemic but either way a 15% increase in a few years is huge!
How do we prevent and treat anxiety disorders?
OK, time for the good news, how do we begin to prevent or treat these issues. While we can’t change our genetics or upbringing, we can often change the degree of stress we’re under, our lifestyle, how we respond to stress, and/or get treatment with more severe cases.
Reducing stressors
It’s helpful to understand what might be causing you stress. Take a blank sheet of paper and draw three columns. In the first column write down all the stressors you might be experiencing (e.g. difficult projects at work). Don’t just stick to the obvious things, really take some time to reflect on the recent days and weeks and come up with a comprehensive list. There might be some things that are not immediately obvious but are actually causing you a lot of stress. In the second column score from 1-10 how much that stressor is affecting you with 10 being the most and 1 being the least. Don’t overthink this too much, it doesn’t have to be perfect, if something really affects you rate it highly, otherwise give it a lower score. Finally, in the third column, score how easy it would be to mitigate or remove that stressor from your life, with 10 being very easy and 1 being very hard.
You can use this to prioritise where you should start with some life changes. Start with things that affect you the most but are the easiest to change. It might be things like avoiding interactions with a certain person, or situations (e.g. public transport at certain times). We often fall into ‘automatic mode’ in life and are not actively managing how we spend our time vis a vis how much stress it causes us. This exercise is a simple way to restore some balance.
Managing stress
If it’s not a stressor you can easily manage away (e.g. caring for a loved one etc.) there are certain coping mechanisms you can bring to the table to help mitigate their effects. These include breathwork, meditation, or journaling (see evidence in the links).
Lifestyle
A balanced lifestyle can set us up well to better manage different stressors. An unprocessed diet, regular and enough sleep, and exercise have all been shown to reduce the risk of anxiety disorders. There are a number of tools out there to help with these including guidance from charities and the NHS, various apps, and professional help (e.g. a nutritionist or personal trainer)
Treatment
For people experiencing anxiety on a regular basis it might be helpful speaking to someone about it. We recommend seeing someone who is on the Health & Care Professions Council’s (HCPC) Register. This ensures they have met certain quality standards. You can find the list here. They might suggest counselling or medication to help.
At Mibio we’re developing an approach to mental health that is based on optimising the gut microbiome. As we mentioned above, the gut microbiome has been implicated in several mental health disorders and certain gut products have been shown to alleviate certain conditions. Visit our website to find more.
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