The Awareness Series: Anxiety Disorders

In all likelihood, many of you will be familiar with it too, whether through personal experience or someone you know, even whether you were aware of it or not. Anxiety disorders are very common, so it’s important you educate yourself about what having an anxiety disorder means, for your own sake, your loved ones, and the sake of others in your community.

I decided to begin my mental disorder awareness series with a disorder I am personally familiar with. In all likelihood, many of you will be familiar with it too, whether through personal experience or someone you know, even whether you were aware of it or not. Anxiety disorders are very common, so it’s important you educate yourself about what having an anxiety disorder means, for your own sake, your loved ones, and the sake of others in your community.

To start, I’m going to clear up a commonly confused interpretation of anxiety. Anxiety is the feeling of anticipation and worry over a future threat, as is perceived by the individual. Everybody experiences this. Feeling anxiety is not exclusive to individuals who have anxiety disorders. During an extremely stressful time, you may experience very intense anxiety, which is normal, and real, and should be attended to. For people with anxiety disorders, however, anxiety plays a more impactful role in their lives. What makes an anxiety disorder a disorder is, surprise surprise, disordered anxiety – anxiety which is excessive, persistent, and having a negative impact on an individuals life or functioning. It most often is brought on by an interaction between genetics and life events, experiences, or learning.

Some don’t understand how anxiety works, which leads to misunderstanding. It’s not as simple as just calming down, or taking some deep breaths, or telling yourself that what’s causing the anxiety isn’t worth feeling anxious about.

 

The Brain and Anxiety:

Inappropriate Threat Perception:

The fight-or-flight response exists to prepare you to face a threat. A threat is something that could cause you harm. Something that is dangerous. This response prepares you to either fight off an attack to defend yourself or to escape to save yourself. In people with anxiety disorders, this response is activated for things that are not actually a threat. For example in social anxiety disorder, one may be anxious and afraid of calling the doctors to the point that their fight-or-flight response is activated. This shouldn’t happen because calling the doctors doesn’t pose any risk or danger – calling the doctor can’t injure or kill you.

Brain Activity in Anxiety:

In the brain, when we perceive something we think is a threat to us, our amygdala (the center of our brain which controls our emotions and survival instincts) gets notified to send us into this ‘fight-or-flight’ mode. In people without anxiety disorders, this should be shut down if what was deemed threatening is realised to not actually pose you any risk, this is processed by your prefrontal cortex (your major logic and thinking region). Your prefrontal cortex then can communicate with your amygdala and stop the anxious response.

In the brains of people who have anxiety, however, scans show that there is lower than normal activity in the prefrontal cortex, and elevated activity in the amygdala. This means that the prefrontal cortex isn’t recognising that the perceived ‘threat’ isn’t a real threat, so it’s not communicating with the amygdala to get it to shut down the fight-or-flight response. This leaves the amygdala to be over-activated, maintaining the feeling of anxiety even if it is a disproportionate reaction.

Chemical Role in Anxiety:

A chemical in our brain called Gamma-Aminobutyric Acid (GABA) also plays a role in regulating our anxiety. When GABA binds to its specialised structures in the brain it lowers brain activity by reducing the electrical impulses. When we experience anxiety, GABA gets released as part of a cycle to prevent prolonged anxiety by reducing electrical activity in the amygdala, allowing, essentially, for you to relax. In people with anxiety disorders, there is overexposure to the stress hormone cortisol due to prolonged and excessive stimulation of the fight-or-flight response. This exposure to cortisol eventually results in a break down of these specialised structures in the hippocampus (a brain area involved in memory and emotion, part of the anxiety regulatory system) that GABA binds to. These structures are required for GABA to carry out its function. Fewer of these structures means less GABA can take effect. This means when you have an anxiety disorder, activation of the fight-or-flight response doesn’t get turned off as quickly as in someone without an anxiety disorder, and their anxiety isn’t as regulated, because this chemical in the brain has less opportunity to take effect.

 

Treatment:

There exists a variety of treatment options available for those who suffer anxiety.

  • Different prescription drugs exist that can improve chemical functioning. They can relieve excess exposure to cortisol, allowing broken down structures in your brain to rebuild so that GABA can work properly. Some increase the functioning of other beneficial chemicals that improve anxiety symptoms such as serotonin. Doctors work with you to ensure they work well for you individually and are appropriate. The use of medication is better paired with therapy to treat the root cause as well.
  • Cognitive Behavioural Therapy can help you change the way you think, so you no longer perceive inappropriate things as threatening.
  • Therapy can also equip you with the tools you need to cope with bouts of anxiety so that it doesn’t have as much impact.

Symptoms and Different Anxiety Disorders:

While I can’t cover all anxiety disorders in this article, keep in mind that anxiety disorders share anxiety as a symptom, and ‘anxitey’ presents its own umbrella of symptoms that are common among the different types. The main differentiation between anxiety disorders is the stimulus that triggers anxious symptoms. For all disorders, for clinical diagnostic criteria to be met, symptoms must cause the individual significant distress and impair functioning or impact their life. If you or someone you know is being affected by anxiety, it’s worth taking some action to get on top of it, treatment really does help.

Different disorders have different criteria, their own extra symptoms, and their own different and specific triggers of the anxiety which differentiate them. Here are some of the more common anxiety disorders:

Generalised Anxiety Disorder:

As is suggested by the name, Generalised Anxiety relates to anxiety which doesn’t have a specific trigger, and can arise from little or no provocation. According to the current diagnostic criteria, Generalised Anxiety involves excessive anxiety and worry that is difficult to control and lasts most days for six or more months.

The anxiety and worry lead to three or more of the symptoms below:

  • Restlessness
  • Easily tired
  • Concentration issues, experiencing ‘mind blanks’
  • Irritability
  • Muscle tension
  • Trouble with sleep

 

Panic attacks and Anxiety:

Panic attacks are a very real and terrifying experience for some who suffer anxiety disorders. Symptoms of anxiety and panic attacks may be similar, however, during a panic attack, the symptoms are significantly more intense. These symptoms may include:

  • Overwhelming fear
  • Racing heart
  • Rapid breathing
  • Trembling
  • Nausea
  • Sweating
  • Chest pain
  • Dizziness
  • Feeling of choking
  • Fear of death
  • Numbness or tingling
  • Feeling disconnected from yourself and/or your surroundings
  • Chills or hot flashes

Anxiety may build up gradually to exhibit some of these symptoms as a response to a stressor. Panic attacks often occur without provocation or warning, although they can also occur as a response to a stressor as well. Because of the severity of these symptoms during a panic attack, unlike anxiety, the experience may feel like a medical emergency, resulting in the fear of death or of losing control.

Phobic Disorders:

Phobic disorders are anxiety disorders where there is a specific thing, whether it be an object or situation, that the person responds to as a threat, even though it doesn’t pose any danger. In phobias, people go out of their way to avoid encountering their fear. If they are exposed to their fear, they feel extreme discomfort and anxiety which may result in a panic attack.

Examples of phobias include agoraphobia and social anxiety/social phobia, and some common and more well-known triggers such as snakes, spiders, blood, and needles.

Agoraphobia:

Agoraphobia is often thought to be a fear of leaving the home or being outside, and while this can be a part of agoraphobia, that’s not what the disorder exactly is. Agoraphobia is an anxiety disorder which involves extreme anxiety or fear about more than one of the following situations in which they may not be able to escape or get help if they begin to panic:

  • Public transport
  • Open space
  • Enclosed space (e.g. aeroplanes)
  • Being in a queue or a crowd
  • Being alone out of the house

Social Phobia:

This is an anxiety disorder I personally struggle with and is also very common. People with social anxiety disorder fear that they will behave in a way, or show anxiety symptoms (for example, blushing or sweating) that will cause embarrassment or humiliation.

Some activities which may be affected by social anxiety include things such as eating in front of others, asking for help in a shop, answering or making phone calls, public speaking or performing, meeting or talking to new people, or even being observed doing some kind of motor skill such as writing, running, or playing a sport. In some cases, it can cause extreme self-awareness resulting in the inability to perform behaviors naturally, which causes more anxiety.

Obsessive Compulsive Disorder (OCD):

People often joke about OCD, but the reality is that the disorder severely impacts the lives of those who have it. The obsessions or compulsions that an individual has are time-consuming and interfere with their day-to-day functioning or cause them distress or harm.

Obsessions in OCD are intrusive thoughts or impulses that are unwanted and may be disturbing, out of character, against their wants or needs, and that the individual may or may not know are irrational or extreme. The intrusive thoughts may cause the person a lot of distress as, even if they know it is extreme, depending on the nature of their obsession, they can truly be fearful for the wellbeing of others, even that they may cause harm to their loved ones.

The anxiety caused by these thoughts can result in behaviors adopted in order to cope. These behaviors are called compulsions. The behaviors may be used to prevent anxiety or distress, reduce it, or prevent something terrible they believe may happen from occurring. They’re defined as repetitive physical or mental behaviors. The behavior may be not connected in any logical way, or they may be obviously excessive.

 

 

Anxiety disorders are more complex than they appear, and can really impact peoples lives. Encourage people who are suffering to get help, or seek help yourself if any of this sets off alarm bells for you. Anxiety doesn’t define who you are as a person, it isn’t an expression of who you are, but an expression of an affliction you have to deal with.

 

 

 

 

References:

1. Martin, E. I., Ressler, K. J., Binder, E., & Nemeroff, C. B. (2009). The neurobiology of anxiety disorders: brain imaging, genetics, and psychoneuroendocrinology. Psychiatric Clinics, 32(3), 549-575.

2. Lydiard, R. B. (2003). The role of GABA in anxiety disorders. The Journal of clinical psychiatry, 64, 21-27.

3. Nuss, P. (2015). Anxiety disorders and GABA neurotransmission: a disturbance of modulation. Neuropsychiatric disease and treatment, 11, 165.

4. American Psychiatric Association. (2013). Diagnostic and statistical manual of mental disorders (DSM-5®). American Psychiatric Pub.

5. Verywellmind. What Happens to Your Body During a Panic Attack?https://www.verywellmind.com/what-happens-to-your-body-during-a-panic-attack-3024889.

6. Thriveworks – Counseling and Coaching, (2017). Agoraphobia DSM-5, Causes, Symptoms and Treatment 300.22 (F40.00). http://thriveworks.com/blog/agoraphobia-causes-symptoms-treatments/

7. Social Anxiety Institute. DSM-5 Definition of Social Anxiety Disorder. https://socialanxietyinstitute.org/dsm-definition-social-anxiety-disorder

8. Beyond OCD.org. Clinical Definition of OCD. http://beyondocd.org/information-for-individuals/clinical-definition-of-ocd

Study For Success: Do’s and Don’ts

If you’re wanting to give your grades a boost or ensure that the information you’re studying actually gets learned rather than being forgotten the instant you leave the exam room, you’re in the right place. Here are some methods to ditch, and some to adopt to perform to your potential.

Whatever level you’re at with your education, you want to be putting your best foot forward when it comes to studying. Unfortunately, research has shown that the most commonly used and popular methods of study are actually relatively ineffective for your learning and remembering. Lesser known are the successful, proven methods that actually work.

If you’re wanting to give your grades a boost or ensure that the information you’re studying actually gets learned rather than being forgotten the instant you leave the exam room, you’re in the right place. Here are some methods to ditch, and some to adopt to perform to your potential.

 

Common Mistakes:

Learning Styles:

There is a commonly believed and promoted myth that studying in accordance with ones preferred mode of learning is the most effective study strategy. This is the myth of ‘learning styles.’ Just because it’s plausible, doesn’t mean it’s true. The vast majority of individuals do not fit perfectly into tidy boxes, we are more complex than that. As with most things, we all lie somewhere on a spectrum, not entirely one thing, and not quite another, often somewhere in between.

In one study, students who were instructed to use their self-prescribed learning style to study either performed equally as well as, or worse, than the control group who studied without this instruction. Moral of the story: don’t confine yourself to a ‘learning style’ when there are more successful and evidence backed methods out there.

Highlighting:

Highlighting is a trusty go-to for most students. It’s easy to do, makes you feel like you’re actively engaging with material, and adds some aesthetic points to your notes. It seems like a win-win, but unfortunately, it’s basically useless, (sorry). Highlighting has been shown to have no impact on learning. Basically, studying with highlighting does nothing to improve your performance, so you’d be better off-putting your effort into a study method that’s actually going to do you some good.

The issue that’s been found with highlighting is that it tends to be misused. It can be an effective method if used properly, because highlighted information stands out more than unhighlighted text, helping you to remember it. We tend to, however, either over highlight or under highlight. Over highlighting stops the highlighted text from standing out anymore rendering it pointless, while under highlighting misses important information. It’s also been shown that performance suffers when you are tested on the information you missed out of your highlighting.

Essentially, highlighting as a study technique on its own is unhelpful. I would advise that you use highlighting to complement other techniques, to allow you to go back and identify the information you want to cover.

Rereading:

This again is a super common method, and while it does improve performance above if you hadn’t studied, it’s one of the less effective methods. If you are pressed for time or don’t have time to learn how to properly use one of the highly effective techniques shown here, rereading is worthwhile. On the occasions when you’ve left yourself enough time to not have to cram, you’re better off using your time doing something else.

Often, we mistake the improved ease in reading a text for having learned the material. This is called the ‘illusion of competency,’ and is just the result of familiarity with the writing improving fluency. The benefits of rereading are actually, unfortunately for all of us who do this, not very significant.

Summarisation:

Once again, summarising information seems like a good idea, which is why a lot of us do it. It can be a good idea too, but only if you know how to do so effectively, which it turns out a lot of us actually don’t. If you’ve been taught how to summarise, go for it, it’s a good way of further processing information you want to learn, but otherwise, it’s not going to be much help to you, so you’re better off skipping it. If you want to keep using this method but you’ve never learned how to summarize, it’d be a good idea to look into how it’s done for it to be of use to you.

Cramming:

Need I say more? If you use this type of study, you likely know it’s not the best. Leaving it to the last-minute doesn’t allow you to learn properly, you will likely forget the material quickly afterward, miss some crucial information, and you will not perform as well as if you had adequately prepared over time. However, if you really have to, cramming is the only option, and it does improve your performance above if you’d done nothing, so better to give it a shot if you’ve left it too late.

 

Effective Methods:

Practice testing:

Practice testing can be done in many different ways and is a highly effective method of studying, time and time again shown to outperform other common methods. Practicing retrieving information from your memory makes it easier to do so in the future. The benefits of testing withstand time, as it improves how long you retain the learned material. To use practice testing to your advantage, repeat testing until your responses are correct, from there, any further testing will further boost your performance higher still.

Some ideas for this method could be, testing yourself with flashcards, answering textbook questions, using past test papers if you can get your hands on some, or using Cornell note-taking (leave a column blank next to where you’re taking notes and later create questions based on the material in the column for yourself to answer when you go to study). My personal favourite technique is to test my memory by covering my notes, writing out what I remember and elaborating on it as much as I can, checking my notes, and repeat this until I can recollect more, and more accurately. Whatever practice test style you wish to use, you will see benefits from it, although more in-depth, elaborative methods show better performance in tests than do more basic ones.

Distributed practice:

We tend to leave our study for later, closer to a test or exam. While that seems logical, evidence actually shows that spreading your study out is a much more successful strategy. Distributed learning is the act of breaking up your study into separated sessions, with longer breaks proving more successful than shorter breaks. More forgetting between study sessions facilitates learning and improves performance, who’d’ve thunk it?

Obviously, the amount of time you have before a test needs to be taken into consideration, because clearly, you cannot space your study sessions so far apart that you sacrifice the number of study sessions you are able to fit in. To use this method to your advantage, you’d ideally not wait until a test or exam is coming up, but study periodically throughout the whole term or semester. Maybe set aside a day each week, right from the start, to go over what you’ve learned, you’ll be happy you did.

One research paper found that a group assigned to six study sessions, each separated by 30 days, performed better in a test than a group assigned to the six study sessions performed only one day apart. The one day apart study group was found to outperform the group who did the six study sessions back-to-back on a single day (cramming). In addition to this, as would be expected, distributed practice testing performs better still than distributed study.

Teaching others:

Join a study group to discuss and help one another understand the content of your class, or bug your family and friends by teaching them about what you’re learning. Teaching other people is a performance boosting study tactic. Explaining to others can help you understand what you’re learning better, and also help you identify holes in your knowledge.

A study showed this to be effective, by comparing the test results of three different groups. One group studied as they normally would, another prepared a lesson on the topic, and the third taught the information as a study method. The group that prepared a lesson out-performed the normal study group and the group who taught a lesson outperformed them both.

Environment:

Location, location, location! Its been found helpful for your ability to recall information to study it in an environment similar to that in which you will be required to recall it. So basically, if you will be in a silent classroom test condition, then you should study in an environment as close to this as you can get. If your tests are held in the same place as your lectures, attending your lectures will help in your tests because being in the environment in which you learned material can help to trigger memories of it.

Studying in the same space, and not using that space for any other activities, helps you build an association with that location and studying, making it easier to concentrate. It can be tricky to concentrate in a spot you’re used to doing something else in.

Sleep:

I’ve said I before, but I will say it again. Sleep is so important! Make sure you get some good sleep after your study sessions and before your test. While sleep is not a study method in its own right, it’s included here because it will help all your hard work pay off.

Consolidation occurs during Short Wave Sleep, transferring memories from temporary storage in your hippocampus, to long-term storage in your neocortex, stabilising them. During sleep, your brain processes information which is useful for your future plans, and transfers the information you learned but weren’t conscious of, into consciously known information.

 

If you’re gonna do it, you may as well do it right. Ditch your old study methods and give your performance a boost with these well researched and evidence-based study hacks. You have the resources you need right here to help you smash your goals.

 

For more advice for students, see my post: 7 Tips From a Bad Uni Student to New Uni Students

 

 

 

References:

1. Kirschner, P. A. (2017). Stop propagating the learning styles myth. Computers & Education106, 166-171.

2. Rogowsky, B. A., Calhoun, B. M., & Tallal, P. (2015). Matching learning style to instructional method: Effects on comprehension. Journal of Educational Psychology, 107(1), 64-78.

3. Dunlosky, J., Rawson, K. A., Marsh, E. J., Nathan, M. J., & Willingham, D. T. (2013). Improving students’ learning with effective learning techniques: Promising directions from cognitive and educational psychology. Psychological Science in the Public Interest14(1), 4-58.

4. Born, J., & Wilhelm, I. (2012). System consolidation of memory during sleep. Psychological research76(2), 192-203.

5. Nadel, L., & Willner, J. (1980). Context and conditioning: A place for space. Physiological Psychology, 8(2), 218-228.

6. Fiorella, L., & Mayer, R. E. (2013). The relative benefits of learning by teaching and teaching expectancy. Contemporary Educational Psychology38(4), 281-288.