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GENERAL

What is anxiety?

Positive or negative anxiety
Anxiety is a condition that all of us experience at certain stages of our lives, even if only for a few minutes. In some situations, anxiety is commonplace and healthy, for the body is then "forced into readiness" to deal with physical danger, realistic concerns or situations in which one would normally feel tense. It becomes positive stress (eustress) named. One experiences e.g. some anxiety when trying something new or participating in a race. The body responds to positive anxiety by injecting more adrenaline into the muscles, beating the heart faster and narrowing vision.

However, if the body "exaggerates" this anxiety (if there is not really a logical reason for the feeling of anxiety) or if it occurs more frequently than necessary, or to a degree that is exaggerated compared to the threat (e.g. a panic attack when someone sees a picture of a snake) we are talking about an anxiety disorder (distress).

* Most people experience some anxiety at some point. When someone reads the symptoms of the various disorders, many signs may seem familiar. However, it is important to remember that one's level of discomfort must be seen on a scale, for example:

No discomfort
Unbearable discomfort

The closer someone's anxiety / discomfort level moves to -10 (minus 10), the more their functioning will be affected. Then it becomes more urgent to get professional help.

Each anxiety disorder describes a certain grouping of symptoms that usually occur together, but symptoms can also overlap and change from time to time.

Anxiety is often only the proverbial tip of the iceberg that protrudes above the water. Below the surface there may be many other problems that need attention, e.g. low self-esteem, substance abuse, co-dependency, etc. Allow yourself enough time to exploit the full extent of the problem and grow through it.

QUESTIONNAIRE

Do you or a loved one have a problem with anxiety?

Follow the link to the Hospital Anxiety and Depression Scale (HADS) below, which may give an indication. Please remember that only a registered psychologist can make a diagnosis.

Download Document

THERAPY

General information on treating anxiety disorders

Why is treatment necessary for anxiety disorders?
Without the right treatment, the symptoms of anxiety disorders can gradually worsen. Anxiety disorder can be used in this way with other diseases, e.g. diabetes, be compared. Both require ongoing pharmacological treatment (medication) and monitoring by a professional. The results of this are generally much better if the person regularly receives psychotherapy from a psychologist. Professional treatment is extremely important for anyone who has been diagnosed with anxiety disorder because there is a significant chemical underpinning of symptoms and it is difficult to keep the symptoms under control (this may escalate) without medication and / or psychotherapy.

The effects of untreated anxiety disorder can be far reaching and contribute to the development of the following problems:

  1. depression or burnout
  2. alcohol or drug dependence
  3. co-dependency
  4. eating disorders
  5. Spastic Colon
  6. irritable bowel syndrome (irritable bowel syndrome)
  7. heart ailments
  8. type 2 diabetes
  9. social isolation
  10. problems in the work situation
  11. problems in intimate relationships

Who can diagnose me or a loved one?
An accurate diagnosis is very important. Therefore, first start by requesting a full medical examination from your GP to make sure there is no medical explanation for your symptoms; if not, the next step is to make an appointment with a psychologist or psychiatrist who can fully assess and diagnose you.

All psychological diagnoses are complex; therefore, we recommend that you be tested and diagnosed only by a registered psychologist or psychiatrist. They are trained to distinguish between different psychological disorders with similar symptoms.

What role does a psychologist play in my treatment?

A psychologist can diagnose psychological conditions and treat psychotherapeutically. This means that the person can help you understand what your diagnosis is, how to live with it and how to apply a strategy that can lead to behavioral change. A psychologist in South Africa may not prescribe medication and usually works in a team with a psychiatrist.

What is the difference between a family doctor, a clinical psychologist and a psychiatrist?

  1. Family doctor: A family doctor completes seven years of study in medicine. Because they do not specialize in psychiatry (such as a psychiatrist), they have only limited exposure to the training necessary to diagnose and treat people with psychological / psychiatric conditions. Your family doctor may prescribe medication, but is also ethically required to refer a patient to the appropriate professional, if necessary.
  2. A registered psychologist: A registered psychologist studies (broadly) human behavior and psychotherapy. In South Africa, all registered psychologists must have a master's degree (study period of at least six years) in order to register and be allowed to practice with the Health Professions Council of South Africa (HPCSA). A psychologist works with you in therapy to understand and treat yourself and your diagnosis. There are different categories of psychologists, focusing on different areas (see below).
  3. Psychiatrist: A psychiatrist also completes seven years of study in medicine but specializes in psychiatry, namely the chemical treatment of disorders related to human behavior. So a psychiatrist is the doctor who can diagnose you and, if necessary, prescribe the right medication for your psychological condition.

References to “psychological states” or “psychiatric states” mean exactly the same.

Is there a specific category of registered psychologists that I should consult?
In South Africa, there are currently five different categories within which all psychologists must register. There is an interesting debate about the focus areas (scope of practice) of the various psychologists. Training agencies, the Health Professions Council of South Africa (HPCSA) and those in practice differ on how these areas should be defined.

Here is a simple description of each professional category:

  1. Clinical psychologist
    A clinical psychologist studies human behavior and psychotherapy and, in order to register, must complete at least a master's degree (six years + study) in South Africa, which includes academic work, research and an internship. A clinical psychologist is the person who can help you understand and live with your psychological diagnosis (eg post-traumatic stress disorder).
  2. Counseling Psychologist
    Study a counseling psychologist, just like a clinical psychologist, human behavior and psychotherapy. Like all registered psychologists, a counseling psychologist must complete a master's degree in psychology - which includes an academic, research and practical component. This is followed by an internship that, unlike a clinical psychologist, is usually not done in a psychiatric hospital, but rather in “ordinary” hospitals or counseling units. A counseling psychologist works with you in therapy to help you get to know yourself, understand your vulnerabilities (and diagnosis) and learn to handle life in a healthy way.
  3. Educational psychologist
    An educational psychologist has undergraduate education in education. To be selected for the master's degree in educational psychology, a person must have at least two years of teaching experience. The master's degree consists of theory, practical modules and research. Then a 12-month internship is supervised. An educational psychologist is a person who often works with children, teens and students on issues that affect their (ability to) learn and develop. Such a person can also make diagnoses related to these issues, e.g. anxiety, depression, trauma, barriers to learning and developmental delays. Parents are also often used to equip them to support their child / teen / student.
  4. Industrial Psychologist
    An industrial psychologist focuses on organizations and the work environment and can make a valuable contribution in the human resources department of a company.
  5. Research psychologist
    Research psychologists focus on academic advancement in the field of psychology and do research on psychological themes and phenomena.

These different categories determine the focus areas within which psychologists must adhere to regulations and the ethical and legal requirements that they must adhere to. According to the HPCSA, only a clinical psychologist can make a clinical diagnosis.

How do I prepare for my first appointment with a doctor or psychologist?

If your anxiety levels are too high, ask a family member or friend to go with you to the first appointment.

You can take the following with you:

  1. a list of the signs and symptoms you are experiencing and how long you have been experiencing them;
  2. a list of things that you avoid, or have stopped doing, because of your anxiety / stress;
  3. medical information about any physical conditions you may have;
  4. a list of the medication (including natural supplements) and the doses you are currently taking or have recently taken; and
  5. a list of questions you want to ask the psychologist.

SELF-MANAGEMENT

What can you do to relieve your anxiety levels yourself?

General recommendations for good lifestyle choices that reduce anxiety:

  1. learn stress management skills
  2. regular physical exercise or activities
  3. a balanced diet
  4. limited alcohol intake
  5. limited caffeine intake
  6. enough sleep

HELP

What are the benefits of support groups?

A support group can be invaluable to someone suffering from a mood disorder. Within the group, people share their “stories” and challenges and learn from each other's skills and experiences. However, finding a support group in one's environment is not always easy. Online searches can sometimes yield good results. More information can be found on the SADAG website found.

ADVICE

Advice for loved ones and family members who live with or work with someone diagnosed with anxiety

If a loved one or friend is diagnosed with anxiety, your support and motivation can play a very important role in accepting and managing their diagnosis. Here are some guidelines to help someone:

  1. Be patient. People who are faced with the diagnosis of a mood disorder do not always have the ability to say how they feel or what they are experiencing. Give them a chance to get used to the diagnosis first and gradually work out an actual plan on how to manage their lives going forward.
  2. Be informed about anxiety disorder. The more you and your loved one, family member or colleague know about the disease, the better you can work on a plan to help the person
  3. Ask what your loved one expects of you. One can easily think you know what is best for another person, but the easiest is to ask how he / she wants you to act.
  4. Listen to the person and do not constantly advise or try to reason logically. It is important for an individual to take responsibility for the illness and the effect it will have on his / her life. Making choices on behalf of someone else may cause people to become dependent on you and then not want to fight the disease themselves. It is not your illness, but your loved one's. Listening is a wonderful way to support your loved one.
  5. Do not condemn. Each of us has our own challenges that we face constantly. Someone with anxiety does not choose to be anxious. It may be difficult to understand if one has not already struggled with anxiety, but it is important to listen, support and encourage rather than condemn and criticize.
  6. Get to know the signs and symptoms so you can act early. Everyone's symptoms of anxiety do not manifest in the same way, so it is very important to understand how the person appears in your life's symptoms. When your loved one e.g. suddenly experience significantly more anxiety than other times, you can start acting proactively by the person e.g. awareness of what you see happening.
  7. Take part physical activities together with the individual. It is not a cliché that regular exercise helps people deal with psychological diagnoses. Exercise relieves tension and anxiety and aids in the production of low-mood transmitters. So regular exercise is actually a successful antidepressant.
  8. Encourage a healthy eating and sleeping pattern. An established routine not only helps the person manage their illness, but also helps to see the signs / symptoms of it early.
  9. Take a good look at yourself! Remember, a person with a diagnosed mood disorder can also negatively impact you by involving you in their disorder. Living with a person diagnosed with a mood disorder can feel frustrating, exhausting and sometimes chaotic. Make time for yourself too.

GENERAL DISEASES

General

General

Healthy anxiety develops into an anxiety disorder when it starts to negatively impact one's life, such as:

  1. to reduce your productivity;
  2. to cause you to be unable to function as in the past in your everyday life; and / or
  3. to cause pain and problems in your body.

People who suffer from generalized anxiety disorder often also have a low self-esteem and are sensitive to criticism, rejection or being ignored. They usually have poor coping skills and tend to go to extremes to avoid situations that make them anxious. Poor coping mechanisms can make them vulnerable to other mental health problems, e.g. addiction.

Did you know?
About three to eight percent (3-8%) of adults in South Africa will experience generalized anxiety disorder at some point in their lives.

What are the symptoms?

What are the symptoms of a generalized anxiety disorder?

The following symptoms are indicative, based on the Diagnostic and Statistical Manual of Mental Disorders (DSM – 5), which is widely accepted as the most authoritative source worldwide.

The symptoms differ from person to person. Some people will experience more cognitive symptoms (concentration, thinking, memory), while others will experience more physical symptoms (muscle, stomach, digestion, pain) or a combination.

The symptoms largely involve:

  1. anxious feeling and constant worried to be; and
  2. all the time too expect something to happen only.

To be diagnosable, the anxiety or worry should at least six months be present for a long time and in different contexts (eg at home, work, school, etc.)

Important
Note that an official diagnosis may only be made by a qualified person.
Remember!
The symptoms should not be the result of other physical conditions, such as illness or the use of drugs.
  1. It is difficult to control the worry. This feel as if the anxiety and worry take over and cannot be controlled. Even if one thinks of something else, the "tension" is still present.
  2. The anxiety and worry are related to at least three of the following symptoms that at least six months have been present for a long time:
    1. restlessness, an “on the edge” feeling (It feels like you are upset and unable to relax. You are virtually chronically focused on something bad that is going to happen.);
    2. becomes easily exhausted and struggles with fatigue (You easily get tired, tired than one would normally expect from the situation or activity and it feels as if you do not have enough energy.);
    3. struggle to concentrate (Some people say their head feels dull or "foggy"; their minds wander easily and they struggle to focus on something and / or remember facts.);
    4. irritability (Because one feels so “on the edge”, you easily get upset when something unexpected happens or not the way you want it. You can then become irritated or scratchy.);
    5. muscle tension (Many people carry their tension in their body and will typically struggle with muscle spasms in their shoulders or back.); and / or
    6. a disturbance in the sleep pattern (Someone struggles to fall asleep, wakes up frequently, has difficulty sleeping through, sleeps restlessly and / or gets up tired.).
  3. The symptoms have a negative effect on a person's functioning and cause discomfort.
  4. The symptoms are not better explained by another disorder, e.g. post-traumatic stress, a phobia, depression, an eating disorder or schizophrenia.

Although it does not form part of the diagnosis, we do see in our practice that clients who struggle with generalized anxiety also sometimes experience problems with their stomach and / or digestion. Anxiety can sometimes also have an effect on excretion, e.g. constipation or symptoms similar to diarrhea. There are also regular customers who mention that they become nauseous or vomit from anxiety. Physical pains can also appear or worsen.

Therapy

Treatment of generalized anxiety disorder

Why is treatment necessary for generalized anxiety disorder?
Generalized anxiety disorder can be successfully treated, but then professional treatment is required. The condition rarely clears itself. Without treatment, symptoms can worsen and lead to medical / physical problems. Untreated anxiety can also make you vulnerable to other mental states eg. addiction en eating disorders.

What would a general anxiety treatment plan look like?

From an integrated approach, we usually propose a combination of the following strategies:

Important
A psychiatric condition or diagnosis is never an excuse for inappropriate or inappropriate behavior. The diagnosis is meant to help someone better understand themselves and get the appropriate treatment for it so that they can learn to manage themselves in a healthy way.
Did you know?
Common anxiety is more common among women than men.
  1. Diagnosis
    An accurate diagnosis is very important. Therefore, start by requesting a complete medical examination from your GP to make sure there is no medical explanation for your symptoms; if not, the next step is to make an appointment with a psychologist or psychiatrist, who can fully assess and diagnose you.
  2. Medication
    The first step is usually medication, which is prescribed by a family doctor or psychiatrist or, if you cannot afford it, by a medical practitioner at any general hospital's casualty department or clinic.
  3. Therapies
    Along with medication, the help and support of a registered (clinical, counseling and sometimes educational) psychologist, registered counselor or even a spiritual leader or trusted, trained, counselor in your community is extremely important. Medication is highly successful in treating anxiety disorder and works the fastest, but in the long run it is worth learning within a therapeutic relationship to understand and manage your anxiety.
  4. Support groups
    A support group can be invaluable for someone suffering from an anxiety disorder. Within the group, people share their “stories” and challenges and learn from each other's skills and experiences. However, it is not always easy to find a support group in one's area. Online searches sometimes return good results. More information can be found on the SADAG website found.
  5. Lifestyle
    Managing anxiety effectively usually requires a healthy, balanced lifestyle. This means that time is devoted to self-care. Regular exercise or physical activities such as walking or jogging, time to relax and a balanced diet are usually suggested. Certain foods (eg caffeine), medications (eg stimulants) and drugs (eg alcohol) can aggravate anxiety and should therefore be limited.

Does this mean that people who do not have access to medication, or cannot afford it, can do nothing about an anxiety condition?
Not necessarily. One can combat anxiety through a healthy lifestyle, meditation and physical exercise, which is actually ideal. Such a lifestyle only takes longer than medication to control the symptoms. Basic medications for generalized anxiety disorders are also relatively inexpensive.

Note: Although there are numerous safe options for anxiety medication, certain medications, e.g. benzodiazepines, extremely addictive and should therefore in ALL cases only be prescribed by a doctor. It is also EXTREMELY important that it is taken exactly as prescribed, and never more than the prescribed dose.

If someone is susceptible to addiction, it is crucial that the doctor or medical practitioner is informed.

Questionnaire

Do you or a loved one have a problem with anxiety?

Follow the link to the Hospital Anxiety and Depression Scale (HADS) below, which may give an indication. Please remember that only a registered psychologist can make a diagnosis.

Download Document
Did you know?
Most people with general anxiety disorder say that they have been struggling with excessive anxiety all their lives. Symptoms can start early in life and worsen during stressful times.

Read more about general anxiety

Read more about general anxiety:

  1. Chronic Anxiety: Generalized Anxiety Disorder and Mixed-Depression. Ronald M. Rapee and David H. Barlow (Eds). Guilford Press, 1991.
  2. Generalized Anxiety Disorder: Diagnosis, Treatment and Its Relationship to Other Anxiety Disorders. David Nutt, Spilios Argyropoulos and Sam Forshall. Bladwell Science Inc., 1999.
  3. Overcoming Generalized Anxiety Disorder: Client Manual. John White. New Harbinger Publications, 1999.
  4. http://mhic.sun.ac.za/wp-content/uploads/2015/06/Generalized-Anxiety-disorder.pdf

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Important
A psychiatric condition or diagnosis is never an excuse for inappropriate or inappropriate behavior. The diagnosis is meant to help someone better understand themselves and get the appropriate treatment for it so that they can learn to manage their mental state in a healthy way.
Remember!
If a person suspects that he / she or a loved one is suffering from an anxiety disorder, it is important to remember that the condition is treatable and call a professional for help as soon as possible.

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EMERGENCY MEASURES

If you or a loved one is struggling with mental health problems, we suggest the following options:
  1. call your GP (if available);
  2. go to your nearest hospital emergency room;
  3. call one of the following emergency numbers: SADAG (the South African Depression and Anxiety Group) 24-hour helpline: 0800 12 13 14 or suicide crisis line: 0800 567 567; or
  4. contact Wie is ek?