Anxiety disorders are very common. Approximately 1 in 4 New Zealanders will be affected by an anxiety disorder at some stage in their lives. At any one time, 15% of the population will be affected.
Although it may sometimes feel like anxiety controls you, there are things you can do to manage and even overcome an anxiety disorder.
The key things you can do are to take good care of yourself through a healthy lifestyle, get help and support, and learn about anxiety and techniques for managing it.
What is an anxiety disorder?
Anxiety is a normal human emotion. Most people experience some anxiety when facing a new, unknown situation, a stressful event happens or something goes wrong in their life. However, some people find themselves worrying or feeling anxious so often that it interferes with their day-to-day life. This is a sign that you have an anxiety disorder.
Anxiety disorders are very common. Approximately 1 in 4 New Zealanders will be affected by an anxiety disorder at some stage in their lives. At any one time, 15% of the population will be affected. The types of anxiety disorders include:
agoraphobia (fear of situations where escape might be difficult or embarrassing in the event of anxiety or other incapacitating symptoms).
generalised anxiety disorder
substance/medication-induced anxiety disorder
anxiety disorder due to another medical condition.
You can take a test to assess your anxiety (GAD 7). The test is available in multiple languages. Its aim is to give you a general idea about your level of anxiety rather than provide a formal diagnosis. For example, if you score about 10 on this test, it suggests you might have a moderate level of anxiety and that it would be a good idea to talk to someone who can confirm a diagnosis and help you to manage it.
What are the symptoms of an anxiety disorder?
Generalised anxiety disorder is the most common type of anxiety disorder. This is when you are extremely worried about things or overwhelmed with anxiety and fear – even when there is little or no reason to worry about these things.
Generalised anxiety disorder has a range of psychological and physical symptoms, such as:
a sense of dread
feeling constantly "on edge" or irritable
being easily distracted
irregular heartbeat (palpitations)
dry mouth or excessive sweating
shortness of breath
nausea and or stomach ache
painful or missed periods.
Symptoms can come on gradually or build up quickly. As anxiety increases, it can lead to changes in your behaviour. You may find yourself withdrawing from social contact and not wanting to see your family and friends to avoid feelings of worry and dread.
You can also find yourself needing more 'sick' days and having low self-esteem. With a generalised anxiety disorder, it can be hard to know what the cause is or why certain things trigger you to worry.
Often people with anxiety can be at risk of also having depression.
What is the treatment for an anxiety disorder?
Generalised anxiety disorder can be treated. There is a range of treatments available, including talking therapy, self-care, learning anxiety management techniques and medication. The first step is to talk with your GP who will discuss these with you and together you can decide which is best for you. Your doctor may refer you to a mental health specialist for talking therapy.
Depending on how severe your anxiety is, your doctor may prescribe medication for anxiety. Medication is best used together with other therapies, such as cognitive behavioural therapy (CBT). Medication helps to alleviate symptoms but addressing the underlying issue (either through self-help or therapy) is usually needed to produce long-lasting change.
Antidepressants, mainly selective serotonin reuptake inhibitors (SSRIs) have been found to be effective in managing panic disorder, social anxiety disorder and generalised anxiety disorder. Examples of SSRIs include citalopram, escitalopram, fluoxetine, paroxetine, sertraline. In some people, venlafaxine may be used for panic disorder.
When starting these medications, your doctor will start you on a low dose and, if needed, will increase your dose slowly. This allows your body to get used to the medicine and reduces side effects. You must keep taking your medication every day – not just when you feel anxious.
It may take 4 to 6 weeks to notice the full benefits of the medication. These medications may initially make your symptoms appear worse before you notice an improvement. Other side effects include nausea (feeling sick), headache, sleep problems and sexual problems. Read more about SSRIs and venlafaxine.
Other antidepressants such as tricyclic antidepressants, may be used if SSRIs or venlafaxine are unsuitable or have not been successful. Read more about antidepressants.
Techniques for managing anxiety
You can learn some new skills that make a big difference in how well you manage your anxiety. Instead of the anxiety controlling you and what you do, you can take charge. Things you can do to break out of the cycle of anxiety include:
accepting and tolerating normal anxiety (and knowing when yours isn't)
taking small steps towards doing the things you are worried about coping with, instead of avoiding them
The choices you make every day of how much you move, what you eat, how much sleep you get, whether you take time to relax and whether you smoke or drink are all important to reducing anxiety.
Regular exercise, particularly aerobic exercise, such as walking, swimming or running, is an excellent antidote to stress and tension. Bodies are designed to move, not sit most of the day. Being active for 30 minutes a day or more is one of the best things you can do to improve your mental and physical health. Exercise encourages your brain to release the chemical serotonin, which can improve your mood and make you feel calmer.
Too much caffeine, sugar or fast food can upset the balance in your body and mind that helps you feel well. Caffeine and energy drinks can disrupt sleep, speed up your heartbeat and increase anxiety. Try eating regular meals, a healthy breakfast, more fruit and vegetables and less processed foods. Find out more about healthy eating basics.
While anxiety can affect your sleep, not getting enough sleep can also contribute to making you more anxious. Make sleep a priority. Follow our sleep tips to help with this.
Taking time each day to relax helps to reduce anxiety. Learn relaxation and breathing exercises or try yoga, pilates or tai chi. Spend time outside in nature. Do things that you enjoy, make you feel comfortable or lift your mood. Learn more about looking after your mental health
Smoking and alcohol
Smoking and alcohol have been shown to make feelings of anxiety worse. Aim to reduce your drinking to no more than 1 or 2 drinks per day or avoid it completely. If you smoke, stop! Talk with your doctor/nurse or ring QuitLine for advice, support and nicotine replacement therapy.
Build your support network – a few people you can go to when things are tough. There are also a range of support organisations. Some offer face-to-face meetings where you can talk about your difficulties and problems with other people. Many provide support and guidance over the phone or by email.
Ask your GP about local support groups for anxiety in your area or contact one of these support groups.
Dr Mieke Garrett is a clinical psychologist with experience in both community mental health and private practice. She works with people experiencing a wide range of difficulties but has a particular interest in stress and anxiety, as well as mood disorders. Dr Garrett has also lectured for Massey University and supervised students in the Postgraduate Diploma in Cognitive Behaviour Therapy.
Credits: Health Navigator Editorial Team. Reviewed By: Mieke Garrett, Clinical Psychologist
Last reviewed: 25 Mar 2019
Managing and reducing anxiety
Instead of anxiety controlling you and what you do, you can take charge. Things you can do to manage or overcome anxiety include:
Learning about anxiety can help you manage it. Anxiety is a normal human emotion when faced with threat. However, for some people, lots of everyday things begin to feel like a threat and anxiety begins to limit your day-to-day life. Two tendencies often play a role in this:
you overestimate how likely it is that something bad will happen to you
you underestimate your ability to cope.
This means you worry a lot about what might happen and how you will cope if it does. Often you know logically that the thing you are worrying about is unlikely to happen, but knowing this and reasoning or trying to reassure yourself with facts doesn’t make you feel any better. You feel really anxious in spite of the facts, and sometimes the more you delve into it, research and seek reassurance, the worse you actually feel. This worry sometimes replaces other emotions that you might find hard to experience, such as sadness, grief or anger too.
When you struggle with anxiety, even a very small chance of something going wrong can feel intolerable, particularly if it’s something really important to you. Therefore it’s common to experience an 'allergic-like' reaction to any degree of uncertainty, where the automatic response is to want to get rid of the unknown until you can have absolute certainty, even though that is often not possible in reality.
The worrying can lead to thinking a lot about the same things and making lots of plans for how to control them. Often these events are based in the future, and as they have not happened yet, there are a lot of unknowns and things outside of your control. Naturally, you may start to avoid situations that you are worried about. Or you may try to block out the worry by using alcohol, drugs, overeating or zoning out in front of a screen.
But the more you try to control anxiety and make sure nothing unexpected happens, the more it grows. If you avoid situations, it just gets harder the next time you need to face them. And if you try to block anxiety out or numb it down, that also makes it grow more. You get caught in a cycle of increasing anxiety.
The good news is that there is way out of this cycle. Instead of trying to control things or block out your thoughts and feelings, you can learn how to experience them in a manageable way.
Some useful things to learn about might include:
what else you might be feeling underneath the anxiety
how to notice when you’re engaging in common thinking biases such as catastrophising, and how to think in a realistic and constructive way
how to differentiate productive problem solving from unhelpful worry
how to break solvable problems into simple goals and small steps
how to tolerate uncertainty in the situations where you are worrying and it is not solvable.
There are many books, workbooks, videos, online programmes and anxiety apps to help you understand anxiety and learn practical tips and skills for taking control of your thoughts, feelings and reactions. Most are based on cognitive behaviour therapy (CBT), an evidence-based approach to managing and recovering from anxiety.
Everyone experiences anxiety. It is a normal human response to situations that may include some kind of threat, real or perceived. It can help you to prepare well for big events and to take care in situations that objectively are risky. So, it's important to expect and learn to tolerate some anxiety. However, it's also important to recognise when your anxiety has become unhelpful and take action to counter it.
Take small steps
Taking small steps to face what you are worried you won't be able to cope with is called graded exposure. Graded exposure helps you slowly build your confidence in your ability to cope with the things you have been avoiding.
When you face a fear by doing the thing you've been avoiding, your fight or flight response will be triggered. This is when your brain releases certain hormones into your body so you are ready to fight off or run away from a real threat. It also gets triggered when you feel anxious about things that aren't an actual threat.
If you stay long enough in the situation you are worried about, your fight or flight response – and therefore your anxiety – goes down. If you keep doing it a bit more or staying a bit longer each time, your anxiety still rises at the start each time, but not as much as the time before. Also, you usually find that your fear was unfounded, which is an empowering experience.
When you do the thing that worries you again and again, your anxiety goes away faster each time. Eventually, you find that you can do much more than before without being worried about it.
Mindfulness helps you observe anxiety without reacting to it. By just noticing anxiety, you can avoid some of the traps people fall into. It can help you stop fighting anxiety only to find it come back more. It can also help you stop overthink things to try and find solutions to something that is not solvable. One of the key messages with anxiety is that the more we try to control it and achieve certainty, the more our discomfort and sense of uncertainty tends to increase.
Practice good self-care
The choices you make every day of how much you move, what you eat, how much sleep you get, whether you take time to relax and whether you smoke or drink are all important to reducing anxiety. Read more about self-care for anxiety.
Deal with specific stresses
If some of what you are worrying about is due to other issues that cause stress, such as financial problems, alcohol or drug addiction, stress at work or other mental health conditions, it's important to also address those directly.
Getting help is key to overcoming an anxiety disorder. There are plenty of support groups so you don't feel alone in your struggles. And there are many psychological practitioners who know the proven methods to help you break free from anxiety. You can:
ask your GP about local support groups for anxiety in your area
There are a variety of mobile phone apps for anxiety, stress, depression and general mental health. They can help you learn about your condition, figure out whether your medication is working, record details about your symptoms and some provide tools to help you manage mental health problems. The Health Navigator team has reviewed some mental health and wellbeing apps that you may like to consider.
Online self-help programmes & courses
Here are some online resources that are designed to help people manage depression and anxiety. Some are free, some have a cost, and some require prescription from your doctor.
From Auckland Regional Health Pathways (accessed 3rd October 2019):
Suicidal thoughts are a red flag. If high risk of suicide, request acute specialised mental health assessment.
Consider screening at-risk patients using GAD-2 screening questions.
Take a history, ask about:
symptoms and impairment – do not rely on a symptom count to assess severity, as functional impairment and disability are more important
personal and family history
other risk factors
the needs of any dependent children of the patient.
Consider differential diagnosis and co-existing causes:
Have an open and collaborative discussion about whether to investigate all health concerns. Investigations will not be required for many patients. New onset GAD is rare in older persons and, in such cases, it is important to rule out other disorders.
Consider grading severity of anxiety with GAD-7 (if not already done) to help with management.
See details of management of anxiety on Auckland Regional Health Pathways.
Identify and communicate the diagnosis of GAD as early as possible to help people understand the disorder and start effective treatment promptly. (1.2.2) Consider the diagnosis of GAD in people presenting with anxiety or significant worry, and in people who attend primary care frequently who:
have a chronic physical health problem or
do not have a physical health problem but are seeking reassurance about somatic symptoms (particularly older people and people from minority ethnic groups) or
are repeatedly worrying about a wide range of different issues.
Following assessment and diagnosis of GAD:
provide education about the nature of GAD and the options for treatment, including the ‘Understanding NICE guidance’ booklet
monitor the person’s symptoms and functioning (known as active monitoring).
This is because education and active monitoring may improve less severe presentations and avoid the need for further interventions. (1.2.9)
Step 2: Diagnosed GAD that has not improved after step 1 interventions
Low-intensity psychological interventions for GAD
For people with GAD whose symptoms have not improved after education and active monitoring in step 1, offer one or more of the following as a first-line intervention, guided by the person’s preference:
*A self-administered intervention intended to treat GAD involving written or electronic self-help materials (usually a book or workbook). It is similar to individual guided self-help but usually with minimal therapist contact, for example an occasional short telephone call of no more than 5 minutes.
Key points to raise – related recommendations:
Individual non-facilitated self-help for people with GAD should:
include written or electronic materials of a suitable reading age (or alternative media)
be based on the treatment principles of cognitive behavioural therapy (CBT)
include instructions for the person to work systematically through the materials over a period of at least 6 weeks
usually involve minimal therapist contact, for example an occasional short telephone call of no more than 5 minutes. (1.2.12)
Individual guided self-help for people with GAD should:
include written or electronic materials of a suitable reading age (or alternative media)
be supported by a trained practitioner, who facilitates the self-help programme and reviews progress and outcome
usually consist of five to seven weekly or fortnightly face-to-face or telephone sessions, each lasting 20–30 minutes. (1.2.13)
Psychoeducational groups for people with GAD should:
be based on CBT principles, have an interactive design and encourage observational learning
include presentations and self-help manuals
be conducted by trained practitioners
have a ratio of one therapist to about 12 participants
usually consist of six weekly sessions, each lasting 2 hours.* (1.2.14)
GAD with marked functional impairment or GAD that has not improved after step 2
For people with GAD and marked functional impairment, or those whose symptoms have not responded adequately to step 2 interventions offer either:
an individual high-intensity psychological intervention, or
Provide verbal and written information on the likely benefits and disadvantages of each mode of treatment, including the tendency of drug treatments to be associated with side effects and withdrawal syndromes.
Base the choice of treatment on the person’s preference as there is no evidence that either mode of treatment (individual high-intensity psychological intervention or drug treatment) is better. (1.2.16)
High-intensity psychological interventions
If a person with GAD chooses a high-intensity psychological intervention, offer either cognitive behavioural therapy (CBT) or applied relaxation. (1.2.17)
If a person with GAD chooses drug treatment, offer a selective serotonin reuptake inhibitor (SSRI). In this UK Guideline, sertraline is recommended as first-line because it is the most cost-effective drug, but at the time of publication of the guideline, (January 2011) sertraline did not have UK marketing authorisation for this indication. Informed consent should be obtained and documented. Monitor the person carefully for adverse reactions. (1.2.22)
Do not offer a benzodiazepine for the treatment of GAD in primary or secondary care except as a short-term measure during crises. Follow the advice in the ‘British National Formulary’ on the use of a benzodiazepine in this context. (1.2.25)
Do not offer an antipsychotic for the treatment of GAD in primary care. (1.2.26)
Key points to raise – related recommendations:
If sertraline is ineffective, offer an alternative SSRI or a serotonin-noradrenaline reuptake inhibitor (SNRI), taking into account the following factors:
tendency to produce a withdrawal syndrome (especially with paroxetine and venlafaxine)
the side-effect profile and the potential for drug interactions
the risk of suicide and likelihood of toxicity in overdose (especially with venlafaxine)
the person’s prior experience of treatment with individual drugs (particularly adherence, effectiveness, side effects, experience of withdrawal syndrome and the person’s preference). (1.2.23)
If the person cannot tolerate SSRIs or SNRIs, consider offering pregabalin. (1.2.24)
See recommendations which cover the issues to be considered when prescribing and monitoring drug treatment.
Step 4: Highly specialised care
Inadequate response to step 3 interventions.
Consider referral to step 4 if the person with GAD has severe anxiety with marked functional impairment in conjunction with:
a risk of self-harm or suicide or
significant comorbidity, such as substance misuse, personality disorder or complex physical health problems or
an inadequate response to step 3 interventions. (1.2.36)
Offer the person with GAD a specialist assessment of needs and risks, including:
duration and severity of symptoms, functional impairment, comorbidities, risk to self and self-neglect
a formal review of current and past treatments, including adherence to previously prescribed drug treatments and the fidelity of prior psychological interventions, and their impact on symptoms and functional impairment
support in the community
relationships with and impact on families and carers. (1.2.37)
Review the needs of families and carers and offer an assessment of their caring, physical and mental health needs if one has not been offered previously. (1.2.38)
Develop a comprehensive care plan in collaboration with the person with GAD that addresses needs, risks and functional impairment and has a clear treatment plan. (1.2.39)
Inform people with GAD who have not been offered or have refused the interventions in steps 1–3 about the potential benefits of these interventions and offer them any they have not tried. (1.2.40)
Consider offering combinations of psychological and drug treatments, combinations of antidepressants or augmentation of antidepressants with other drugs, but exercise caution and be aware that:
evidence for the effectiveness of combination treatments is lacking and
side effects and interactions are more likely when combining and augmenting antidepressants. (1.2.41)
Combination treatments should be undertaken only by practitioners with expertise in the psychological and drug treatment of complex, treatment-refractory anxiety disorders and after full discussion with the person about the likely advantages and disadvantages of the treatments suggested. (1.2.42)
When treating people with complex and treatment-refractory GAD, inform them of relevant clinical research in which they may wish to participate, working within local and national ethical guidelines at all times. (1.2.43)
Continuing medical education
Video series – Mental health in primary care (Pharmac)
Seminar series of 7 video updates about "non-drug therapies for common mental health conditions in primary care: depression, anxiety and distress. With the aim being to encourage practitioners to talk first, get patients being physically and socially active, and see how they do. With prescribing coming later, if and when needed" – from 13th April 2017.
Regional HealthPathways NZ
Access to the following regional pathways is localised for each region and access is limited to health providers. If you do not know the login details, contact your DHB or PHO for more information: