Mental Health First Aid: Anxiety Disorders

By Wasim Kakroo

APPROXIMATELY 1 million adults (26%) in  Kashmir Valley were exhibiting signs of a probable anxiety-related disorder as per reports published by MSF back in 2015 and since then there has been a further increase in the number of cases owing to continuous political turmoil as well as distress created by COVID-19 pandemic situation. Anxiety disorders are not the same as transient nervous sensations or random attacks of worry and fear. Anxiety disorders are diagnosable mental diseases that cause a person’s everyday life to be severely disrupted by acute, recurring symptoms. Anxiety sufferers may experience unpleasant physical, behavioral, and psychological symptoms such as excessive irrational fear, rapid heart rate, digestive problems, and may feel distressed in ordinary circumstances. To cope with overwhelming thoughts and sensations, people with anxiety disorders are more inclined to abuse drugs or alcohol, but this just worsens their condition. Anxiety disorder symptoms might continue in someone’s life eternally if not treated properly.

Anxiety disorders are associated with mental health crises such as panic attacks, suicide ideation, and self-injury. However, if a person receives mental health first aid, a crisis may be managed, and this kind of compassionate action can be the first step toward proper treatment for an anxiety problem.

Mental health first aid is a form of immediate help that you may learn to give to someone who is going through a mental health crisis such as an anxiety spell. Although it cannot replace immediate medical treatment or long-term counselling, as a first aider, you may assist someone in regaining control after an anxiety episode.

RISK FACTORS FOR ANXIETY DISORDER

Anxiety can be triggered by perceived risks in the environment, although anxiety disorders are seldom caused by a single factor. Many different forms of long-term anxiety disorders are caused by a complex collection of risk factors, such as:

• Anxiety and extreme shyness throughout adolescence
• Traumatic life events or experiences
• A sensitive emotional nature
• Seeing the world as threatening
• Adverse childhood experiences
• Medical problems that are difficult to manage, such as heart and respiratory illnesses

People who are most likely to acquire an anxiety disorder are those who: 

• Have a family history of mental illness especially any sort of anxiety disorder and/or mood disorder
• Have a family history of drug or alcohol abuse
• Struggle with drug or alcohol misuse
• Are female (Women are twice as likely as males to suffer from anxiety problems.)

SYMPTOMS OF ANXIETY DISORDER

Anxiety disorders are mental diseases that may impact every part of a person’s body and every aspect of a person’s life. The various symptoms of anxiety disorders include:

• Physical symptoms: Chest discomfort, hyperventilation, stomach pains, muscular aches, and tremors.
• Psychological Symptoms: Excessive or irrational fear and worry, racing thoughts, poor attention and memory, disorientation, restlessness, and sleep difficulties.
• Behavioral symptoms: Avoiding people or social settings, compulsive behaviors such as checking/rechecking, fear of specific objects/situations.

Symptoms of a Panic Attack

As a person who provides mental health first aid, you should be aware of the signs and symptoms of panic attacks, which are brief bouts of intense fear that can appear in any anxiety disorder. Symptoms of panic attack are as:

• Headache
• Shortness of breath, or hyperventilation
• Excessive sweating
• Trembling, shaking or rocking back and forth
• Nausea or vomitting
• Lightheadedness, dizziness, or fainting
• Hot or cold flashes
• Crying
• Rapid heart rate
• Feeling of numbness
• Chest discomfort
• Abdominal pain
• Feelings of detachment from reality
• Fear of losing control
• Fear of dying

ANXIETY DISORDERS: EARLY INTERVENTION

Many anxiety problems start in childhood or adolescence but aren’t diagnosed or treated until later in life. Anxiety disorders aggravate if left untreated, and they can even lead to the development of other mental diseases, substance abuse disorders, or suicidal ideations.

Mental health first aid may be the only compassionate assistance a person receives if their worry goes undetected or ignored by close ones. You may offer support and comfort as a first aider, but you can also persuade someone to get professional help before their illness worsens.

HOW TO TREAT ANXIETY DISORDERS WITH MENTAL HEALTH FIRST AID

If someone you know is facing an anxiety spell, you may help them by following the five-step ALGEE method, which stands for:

• Assess for suicide or harm risk
• Listen without judgment
• Give reassurance and information
• Encourage appropriate professional help
• Encourage self-help and other support measures

ASSESS FOR SUICIDE OR HARM RISK 

You can soothe someone who is having a panic or anxiety attack using the ALGEE plan until proper help comes or can be asked for.

There are numerous forms of mental health crises associated with anxiety disorders. If the person you’re helping is having a panic attack, thinking about suicide, or purposefully harming themselves, you can offer first-aid for

• panic attacks
• Suicide thoughts and behaviours
• Non-suicidal self-injury
• Traumatic experiences

However, if the individual possesses a weapon and threatens to hurt himself or others in any of these situations, contact police or ask for online professional mental health assistance. You can start a conversation with the person and follow the rest of the stages in the ALGEE plan if they are not in an urgent crisis and there is no danger to anyone’s safety.

LISTEN WITHOUT JUDGEMENT

Empathetic listening is one of the most essential aspects of mental health first aid. This reassures the individual that speaking out about their condition is appropriate and encouraged, and that others care about their problems.

Approach the person in a private place and communicate your worries about their anxiety in a polite manner to begin mental health first aid. Asking open ended questions such as, “How have you been feeling lately?” and “How long have you been this way?” can help to strike the conversation in healthy way. If they agree to talk with you, be prepared to listen calmly and patiently to what they have to say.

It’s critical that you listen actively and offer compassion and understanding at this point. The following are some suggestions for being a more engaged listener:

• Maintaining comfortable eye contact and open body language
• Restating what the other person has said
• Using minimum verbal prompts, such as “I see,” and “Ah”
• Asking clarifying questions, which indicates that you want to understand
• Allowing silence and pauses in the discussion
• Practicing patience

Be conscious of how you think and act throughout this talk.

• Don’t judge the person or their emotions
• Don’t try to correct or persuade them that their views are incorrect
• Don’t provide useless advice like “You’ll get over it”
• Don’t fidget with and/or look at your smartphone while talking to them

GIVE REASSURANCE AND INFORMATION

An anxiety disorder can make a person feel afraid in unusual ways. They may feel out of touch with reality and may turn mad, fearing that their loved ones dislike them, fearing that they are unlovable, or fearing that they are a failure.

Although these worries are frequently baseless, they are still invasive and damaging. As a mental health first aider, don’t try to reason with the individual or persuade them that their feelings are unfounded. Do not dismiss their worries as irrational or insignificant as this is harmful, might make them feel guilty, and may discourage them from explaining their anxiety with others. Instead, show empathy for the person’s worries. Reassure them that:

• They need not to blame themselves for their mental illness;
• Their anxiety does not make them less lovable;
• Their anxiety is a disease that requires treatment;
• Recovery from anxiety is achievable;
• You are there to listen if they need to talk again.

ENCOURAGE APPROPRIATE PROFESSIONAL HELP

Many people are unaware of the seriousness of anxiety disorders, and they may assume that anxiety will go away with time. People who suffer from anxiety disorders, on the other hand, do not have to suffer in silence or wait for their symptoms to go away. Individuals suffering from anxiety can seek professional help.

It’s critical that you know when to persuade the person to get professional help. When anxiety lasts for weeks and interferes with a person’s ability to function in everyday life, professional treatment is required. Do not assume that the person’s anxiety will go away on its own. Keep in mind that early treatment of anxiety is critical for the greatest results.

Discuss with the anxious individual and their caregivers how seeking professional help can be beneficial and ask the individual and his family members whether they believe it would be beneficial to them. Discuss getting professional help in a way that normalises it, such as by describing it as a natural activity to do and explaining that mental health issues are common and treatable.

If they believe they need assistance, talk to them about the professional help that is available in their area and urge them to use them. If the person requires assistance, volunteer to assist them.

Encourage the individual to prepare a list of questions to share with the health professional at their initial session if they decide to seek professional treatment. If the individual wishes for you to accompany them to a doctor’s visit, you must not fully take over since a person suffering from depression needs to make their own decisions as much as possible.

As a first aider, you can refer such individuals to mental health professionals such as psychiatrists (medical doctors who prescribe medicines for various mental disorders) and clinical psychologists (mental health professionals who treat various mental health issues using various non-pharmacological modes of treatment such as CBT, family therapy, couple therapy etc.) available at various district hospitals or working in private at various clinics across Kashmir. Counseling if done by a clinical psychologist has been found to be very effective mode of treatment for various types of anxiety disorders. While approaching someone for counseling, try to see if the person claiming to be a professional clinical psychologist has RCI license to work as a clinical psychologist.

What if the person refuses to accept professional help?

If the person refuses to seek professional help, ask whether they have any specific reservations about obtaining professional help. They may have a misunderstanding of how treatment works or be afraid to express their thoughts to others. Reassure them that they have the right to recover from their anxiety problem, and that if they don’t seek expert assistance, it may aggravate.

At the same time, keep in mind that it isn’t your responsibility to resolve their anxiety, and you can’t make them seek treatment. If they’re still unsure after this talk, let them know you’re willing to assist them if they change their minds. All you can do is offer encouragement and treatment suggestions. After obtaining your advice and first aid, it is up to the individual experiencing anxiety to determine how to proceed.

ENCOURAGE SELF-HELP AND OTHER SUPPORT MEASURES 

People who suffer from anxiety disorders, fortunately, have a variety of self-help options available to them. Seeking out the help of others is one of the most helpful strategies. Although your assistance as a first aider is essential, urge the person to discuss their anxiety problem with friends, family members, or other people they trust.

You may also suggest that they try to use self-care activities and self-help methods that will help them develop good coping mechanisms, such as:

• Daily physical exercise
• Eating a variety of fruits and vegetables
• Reading self-help books on how to manage stress in life
• Practicing mindfulness meditation
• Practicing attitude of gratitude on a daily basis

• The author is a clinical psychologist and works as a Child and adolescent mental health counselor at IMHANS-K and can be reached at [email protected] 

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