Facing anxiety

Healthy Food Guide editor Jenny de Montalk offers helpful ways to cope when worry gets too much.

We’ve all been there – heart thumping, palms sweating, fast, shallow breathing, an overwhelming desire to get away or disappear. This feeling is anxiety and, while unpleasant, it’s totally normal, and even necessary in certain circumstances.

What is anxiety?

Anxiety is a natural response to stress. In the short term, it’s useful – making you alert before an exam or interview. Anxiety can also help you avoid life-threatening situations. Tu Te Akaakaroa (Royal Australian and New Zealand College of Psychiatrists) chair Mark Lawrence says the body developed the ‘fight or flight’ reflex to help us escape danger.

“If a hairy beast came running towards you, this is the response that would have you fight the beast or run away,” Dr Lawrence explains.

When a person feels a threat, anxiety and fear trigger the release of hormones, such as adrenalin, that make your heart beat faster, pumping blood into your muscles and vital organs. Rapid breathing takes more oxygen into the brain, increasing alertness. Adrenaline also triggers the release of glucose into the bloodstream, supplying energy to all parts of the body so you can make a faster getaway.

Who is affected by anxiety?

Around 200,000 New Zealand adults have been diagnosed with an anxiety disorder at some point in their lives (6 per cent).

Anxiety disorder rates are higher in women, particularly those between 25-54 years old, but the reasons for this aren’t clear. Varying theories encompass hormones, stress response, and social pressures, including lower help-seeking rates among men. Supporting evidence for these theories is still being gathered. One animal study found female rats’ brains react more sensitively to stress than male rats’ brains do, but more investigation is needed to see if this can be replicated in humans. Separately, a US survey of 22,581 working adults found a relationship between the gender pay gap and higher rates of anxiety and depression in women, which reduced when women were paid equally or more than men.

When is anxiety a problem?

Dr Lawrence says anxiety, like depression, only becomes a disorder when your symptoms meet a set of clinical criteria. For instance, when you excessively worry or are anxious most of the time about a range of things, or your anxiety impacts your day-to-day functioning.

There are multiple anxiety disorders, the most common of which are generalised anxiety (GAD), panic, social anxiety disorder (SAD), post-traumatic stress (PTSD) and obsessive compulsive (OCD) disorders.

Generalised anxiety disorder

The Anxiety New Zealand Trust characterises GAD as chronic and exaggerated worry and tension, even when nothing seems to provoke it.

“Having this disorder means always anticipating disaster, often worrying excessively about health, money, family or work. Sometimes, though, the source of the worry is hard to pinpoint. Simply the thought of getting through the day provokes anxiety.”

Someone with GAD will be excessively anxious or worried about a variety of things and find it hard to control that worry. She may feel restless, irritable, easily fatigued, have difficulty concentrating, muscle tension or sleeping difficulties. The symptoms may be so strong she has difficulty functioning in daily life.

Social anxiety disorder

People with SAD, sometimes called ‘social phobia’, fear and avoid the scrutiny of others, worrying something they say or do might result in embarrassment or humiliation. SAD can make a person so anxious they avoid social situations altogether, or are intensely uncomfortable in them. It might not be obvious how uncomfortable a person with SAD is, but he may be feeling intense emotional or physical symptoms, including fast heart rate, sweating, trembling or trouble concentrating. Sometimes he might appear stand-offish or aloof. Often people with SAD are coping with extremely low self-esteem, high self-criticism and, sometimes, depressive symptoms.

Panic disorder

When a person has panic disorder she has recurrent, unexpected panic attacks and persistently worries about having more panic attacks. She may also change her behaviour to avoid situations that might trigger a panic attack, such as driving or being in unfamiliar situations.

Panic attacks are a terrifying experience and can make the sufferer feel out of control, as if she’s going mad or might die.

Symptoms of a panic attack

• palpitations, pounding heart
• sweating
• trembling or shaking
• shortness of breath
• feeling of choking
• chest pain or discomfort
• nausea or abdominal distress
• feeling dizzy or faint
• chills or heat sensations
• numbness or tingling
• feelings of unreality, being detached
• fear of losing control or going crazy
• fear of dying

Post-traumatic stress disorder

When a person experiences an extremely traumatic event such as war, a car crash, or abuse, he can develop PTSD. The disorder can manifest in intrusive thoughts, nightmares, flashbacks, distress and physical reactions. After the trauma that triggers PTSD, a person might have memory blanks about what happened and can develop overly negative thoughts about himself or the world. He also might unfairly blame himself or others, be hyper-vigilant, irritable or aggressive, engage in risky or destructive behaviour and have difficulty sleeping or concentrating.

Obsessive compulsive disorder

OCD is a term often casually tossed around to describe someone who has perfectionist or slightly obsessive personality traits, but a person really suffering with this disorder can experience symptoms that are very disruptive to her life. OCD is characterised as having repetitive and unwanted thoughts or impulses that cause anxiety and are hard to stop. The Mental Health Foundation explains compulsions as ‘repeated actions or behaviours that you feel driven to do, even though you know they are unnecessary’. In a person with OCD, compulsions are usually linked to obsessional thoughts. For instance, she might think germs left on a surface will make her sick, so she feels compelled to wash her hands repeatedly. She may feel less anxious by acting on the compulsion to wash her hands, but the relief is temporary.

What helps with anxiety?

Treatment for anxiety disorders usually involves therapy and, depending on the severity, medication. Dr Lawrence says the types of medication used for treating depression are often used to treat anxiety disorders but in higher doses (for more on therapy and medication, see ‘How is depression treated?’ in our article Tackling depression).

On top of this, people with anxiety benefit from maintaining good physical health.

A population study of twins in the Netherlands found people who exercised regularly were, on average, less anxious and depressed than non-exercisers.

A healthy diet can also be beneficial. Some researchers suggest eating antioxidant-rich foods might help, as anxiety is correlated with a lowered antioxidant state.

Antioxidant-rich foods and drinks

• Vegetables of all colours, such as asparagus, beetroot, broccoli, capsicum, red and green cabbage, garlic, kale, onions, silver beet, spinach, tomatoes and watercress.
• Berries, such as blackberries, blueberries, boysenberries, raspberries and strawberries.
• Nuts, such as walnuts, pecans, hazelnuts and Brazil nuts.
• Drinks such as green or black tea, coffee (not too much if it increases your anxiety) and cocoa.
• Herbs and spices, such as rosemary, sage, thyme, cumin, ginger and turmeric.

Gut-friendly food

Prebiotic foods:

• asparagus
• cooked and cooled pasta or potatoes
• firm bananas
• garlic
• Jerusalem artichokes
• leeks
• legumes
• onions
• whole grains

Probiotic food and drink:

• kefir
• kimchi
• kombucha
• miso
• pickled vegetables (naturally fermented)
• sauerkraut
• tempeh
• yoghurt with live cultures

Evidence is emerging of the relationship between gut health and mood disorders. Animal and human trials have found certain probiotics potentially help with anxiety. Probiotic foods contain live bacteria that add to your gut’s population of good bacteria, and prebiotic foods feed good bacteria so they can thrive.

It might also pay to include some oily fish in your diet. Some studies have found an association with omega-3 supplementation and lowered stress levels. Limiting caffeine and alcohol is also beneficial. With appropriate treatment, anxiety can be managed, and being in good physical health will help with mental health. If you or someone you know might have anxiety, visit your GP or reach out to one of the support services below.

Where to seek help

• Lifeline 0800 543 354
• Youthline 0800 376 633
• Kidsline 0800 543 754 (weekdays 4-6 pm)
• What’s Up 0800 942 8787 (noon to midnight 7 days, for young people aged 5 to 18)
• Depression Helpline 0800 111 757
• Samaritans 0800 726 666
• Healthline 0800 611 116
• The Lowdown thelowdown.co.nz or free text 5626
• depression.org.nz

Online tools

• SPARX sparx.org.nz – a free online game to help young people learn to deal with depression and anxiety
• The Journal – a free, personalised online program that’s part of the depression.org.nz site John Kirwan promotes
• The Lowdown thelowdown.co.nz – teamed by a group of counsellors who are available on email or text 24/7
• Beating the Blues – an online CBT programme you can access through your GP
• myCompass mycompass.org.au – an Australian interactive self-help program for mild to moderate depression, anxiety and stress
• MoodGYM moodgym.anu.edu.au – another Australian online program to learn CBT skills for preventing and coping with depression
• e-couch ecouch.anu.edu.au – an interactive program using CBT and interpersonal therapies, as well as relaxation and exercise