Tired but wired: Living with anxiety
Anxiety and panic attacks are becoming more prevalent in Ireland, especially among adolescents and young adults. Katie Byrne asks the experts how to manage the symptoms, and how to tell when it's time to seek help
WHEN Dr Harry Barry was invited to speak in front of more than 7,000 second-level students and teachers at the recent Cycle Against Suicide Student Leaders' Congress in the 3Arena, he was asked to focus on a specific topic: panic attacks, and how to deal with them.
"It's a massive issue in schools at the moment," explains Dr Barry, author of the best-selling book Flagging Anxiety and Panic. "And I'm getting non-stop phone calls from parents asking for advice.
"Anxiety is probably the greatest epidemic that we are suffering at the moment in terms of mental health," he adds. "It has always been there but we are seeing a particular acceleration in people of school- and college-going age, from 12 up to 25."
Recent statistics bear out his observations. When the Irish Primary Principals' Network (IPPN) commissioned a survey on children's mental health and emotional wellbeing, more than a quarter of school principals reported a spike in anxiety among their pupils.
Meanwhile, a study that analysed data from early intervention programme Jigsaw found that anxiety is the most common mental health issue among young people (aged 12-25) in Ireland.
Millennials have been dubbed 'the anxious generation', but they aren't the only group at risk. Experts have also noted an increase in anxiety disorders in almost every age bracket, with many attributing it to the dizzying pace of modern life.
"We are going faster and we are performing more than ever, ever before," according to psychotherapist and author of the book Cotton Wool Kids Stella O'Malley. "We're trying harder and that leads to an anxious lifestyle."
Dr Róisín Joyce, lead clinical psychologist with the Evidence-Based Therapy Centre in Galway, agrees. "We are becoming busier and busier and, as a result, more and more disconnected from the things that we need, such as social connection," she says.
"In addition, the growing dependence on social media and internet-based services can lead to disconnection from ourselves and other people."
It's important to understand that anxiety per se is not a bad thing. "It is a normal animal response to threat," explains Dr Joyce. "When we experience the physical and psychological impacts of anxiety, this is the body responding in the way it was designed to respond to threats.
"Anxiety or fear, like all our emotions, have a function. They are communicating things to us about what is going on in our lives. There isn't a human on the planet who has not experienced anxiety along the way - with its associated physical and psychological effects.
"Like everything, there is a spectrum with anxiety," she adds. "While everyone has experiences with anxiety, for some the anxiety takes over and can interfere with the person's ability to function. The reason this happens varies from person to person, but once you understand a person's history and context, the reason they have become anxious makes sense."
A generalised anxiety disorder (GAD) is characterised by the presence of excessive anxiety. According to the classification of GAD in the DSM-5, "Worry occurs more often than not for at least six months and is clearly excessive.
"Excessive worry means worrying even when there is nothing wrong or in a manner that is disproportionate to the actual risk," it reads. "This typically involves spending a high percentage of waking hours worrying about something. The worry may be accompanied by reassurance-seeking from others."
For a diagnosis of GAD, the anxiety and worry must be associated with at least three of the following physical or cognitive symptoms (in children, only one symptom is necessary for a diagnosis of GAD): edginess or restlessness; tiring easily; feeling more fatigued than usual; impaired concentration or feeling as though the mind goes blank; irritability (which may or may not be observable to others); increased muscle aches or soreness; difficulty sleeping (due to trouble falling asleep or staying asleep, restlessness at night or unsatisfying sleep). Many individuals with GAD also experience symptoms such as sweating, nausea or diarrhoea.
Dr Barry says people are often surprised to discover that GAD symptoms are both physiological and psychological. "Many people come to me thinking that they're depressed, but they are not depressed. They are simply just very anxious and they just need someone to teach them how to deal with the physical symptoms of anxiety, which nobody ever talks about."
Social anxiety is another common form of anxiety that affects 16.8pc of Irish people, according to Social Anxiety Ireland. "A lot of young men in their 20s are struggling with it," says Dr Barry. "And as we use our smartphones and become increasingly alienated from talking to each other face to face, social anxiety is going to increase dramatically in years to come."
Anxiety can also manifest as phobias, post-traumatic stress disorder (PTSD) and obsessive-compulsive disorder (OCD) but, for the vast majority of people, the symptoms are either mild or manageable. Their anxiety doesn't lead to panic attacks or irritable bowel syndrome (IBS), and it doesn't require medical intervention.
"Anxiety needs attention when it starts to intrude in your life," explains Dr Barry, "when you're constantly tired because you're burning out - or when you're always catastrophising and living in a constant state of high alert. 'Tired but wired' is a wonderful description. This is when people are fatigued but when they try to rest, they can't switch their minds off.
"They often start to procrastinate. They start to avoid things and put things off. These things then build up, and then they become even more anxious."
Laura Murray (30) from Finglas in Dublin explained these very symptoms to her GP four years ago. "I was feeling very low and I noticed that I was worrying a lot over little things," she says. "I was very self-conscious of getting everything right, and I'd stress out if I got something wrong."
When Laura asked her GP if she thought she should be taking medication, she was told that it would be better for her to learn some techniques that would help her manage the symptoms. She was referred to a counsellor through the medical card scheme, and she had eight free sessions before moving to a donation-only service. She now visits a private counsellor twice a month, paying €70 per session. "I talk about what's bothering me and then he breaks it down to help me cope with that situation. I've improved a lot."
"You can turn general anxiety around quite quickly with some CBT [cognitive behavioural therapy] techniques," explains Dr Barry. "And when you teach people techniques showing them how to deal with procrastination, perfectionism and catastrophising, the person's anxiety level starts to fall rapidly.
For panic attacks, Dr Barry uses a technique called 'flooding', during which he explains to the client how the stress response starts with the amygdala, a structure positioned in the front of the brain's temporal lobe.
"It is the amygdala's job to look for danger," he explains, "and when it senses danger, it releases adrenaline into the body. It is adrenaline that gives you all the physical symptoms of anxiety. We have to teach the person to learn how to go with the physical symptoms of anxiety so that the amygdala can change its memory.
"I can get rid of most people's panic attacks in one or two sessions and I get totally frustrated that something so simple can be dealt with simply by explaining to people what's happening in their bodies."
Dr Joyce, for her own part, likes to use compassion-focused therapy. "If we can start to see that our emotions are part of the human experience, alerting us to potential difficulties in our lives, then we can start to move towards them and work effectively with them," she explains.
"There is an idea that emotions are a sign of weakness, something to be ignored and avoided," she adds. "As a result of these messages, people don't value their emotions; they don't see their emotions as the friends that they are, trying to alert them to problems in their lives and unmet needs."
There are a wide range of tools and techniques available for managing anxiety disorders and, while some people will seek the help of an expert to overcome acute symptoms, many more will try to manage milder symptoms themselves.
They just have to be careful not to exacerbate the issue. Dr Barry has noticed a tendency for women - who are twice as likely to experience anxiety as men - to self-medicate. "The two things that women use, in particular, are alcohol - mostly wine, which is why so many end up in the Rutland [addiction rehabilitation centre] - and tranquillisers. And tranquillisers are a disaster in the sense that they stop the amygdala from changing its memory."
It can be tempting to reach for short-term solutions, but effectively managing anxiety means identifying your triggers - caffeine, alcohol and refined sugar are the big three - and knowing your limits.
Eating well and getting regular exercise are equally important, and most mental health professionals recommend yoga, mindfulness and deep breathing as effective relaxation techniques.
"We seem to have forgotten that, as human beings, we are able to learn information and put it into practice," says Dr Barry. "We seem to think we always need an expert. But, very often, a good book and a good video can go a long way towards healing ourselves."
How I manage my anxiety
Journalist Caroline Foran (29) is the author of Owning It: Your Bullsh*t Free Guide to Living With Anxiety. She lives in Drumcondra, Dublin. Caroline, who is not a healthcare professional, shares her personal experience here:
"I'm very mindful of diet. If I'm feeling kind of stressy, diet will have a huge impact. So I try to avoid sugar, even though I want to comfort-eat. It just spikes my blood sugar and makes it so much worse. I also avoid caffeine and I'm careful with alcohol.
"I used to do a lot of running but I found it was counter-productive because it places a lot of stress on the body. When I was feeling acutely anxious back in the day, I thought I could run it out of me, but after a run I just felt 10 times worse and I couldn't understand why. I've since discovered that I was stimulating my nervous system when it was already overstimulated. Nowadays, I practise yoga and resistance training.
"I have a chapter in the book called 'Bullsh*t-Free Breathing', as a lot of the information on breathing can be quite airy-fairy. When I'm feeling particularly anxious, I breathe in for a count of four and out for a count of eight - when you breathe out for longer, you are lowering your heart rate.
"I'm also very mindful of what I say yes to and of managing my time. I know I have limits and I have a lot more respect for myself these days. When I first developed anxiety, I was always pushing myself on to the next thing all the time. I was all about the CV. I pushed myself from the frying pan into the fire and it blew up in my face.
"I had limits that I wasn't respecting and I should have just enjoyed where I was for a while. I now know that I'm not Superwoman."
Ask for help
Counselling in Primary Care (CIPC) is a short-term counselling service that provides up to eight counselling sessions with a professionally qualified and accredited counsellor/therapist. It is a short-term service for medical card holders, who are 18 years of age or over and who want help with psychological problems that are appropriate for time-limited counselling in primary care. This service is for people with mild to moderate psychological difficulties, including anxiety and panic reactions. Speak to your GP for further information.