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Anxiety definition

Anxiety is an emotion characterized by feelings of tension, worried thoughts and physical


changes like increased blood pressure(American psychological association ,1994 )

Anxiety is best defined as an intense feeling of unease, worry, and fear. It is common to
feel anxiety when faced with a challenging situation ( Yolanda Williams )

Anxiety is the anticipation of impending danger and dread accompanied by restlessness,


tension, rapid heartbeat, and rapid breathing that may or may not be associated with a certain
event or situation (Mosby's Dictionary of Medicine, Nursing, and Health Professions)

A feeling of impending danger that can be based on objective, neurotic or threats


(Sigmund Freud )

An emotional state of a human during life is both life – saving and also causes many
problems in the mental life of human beings. The feeling of worry, nervousness, or unease about
something with an uncertain outcome. When an individual faces potentially harmful or worrying
triggers, feelings of anxiety are not only normal but necessary for survival. (Garner, et.al., 2009)

Anxiety serves as the body’s warning system – the brain’s way of telling the body that
something bad could happen. This response relates to but is distinct from fear, which alarms us
when something actually dangerous is happening or is just about to happen. (Donald , et.al.,
2013)

State and trait anxiety

The concepts of state and trait anxiety were first introduced by Cattell (1966; Cattell
&Scheier, 1961, 1963) and have been elaborated by Spielberger (1966, 1972, 1976, 1979). In
general, personality states may be regarded as temporal cross sections in the stream-of-life of a
person (Thorne, 1966), and emotional reactions as expressions of personality states
(Spielberger, 1972). Although personality states are often transitory, they can recur when
evoked by appropriate stimuli; and they may endure over time when the evoking conditions
persist. In contrast to the transitory nature of emotional states, personality traits can be
conceptualized as relatively enduring differences among people in specifiable tendencies to
perceive the world in a certain way and in dispositions to react or behave in a specified manner
with predictable regularity.Personality traits have the characteristics of a class constructs that
Atkinson (1964) calls “motives” and that Campbell (1963) refers to as “acquired behavioral
positions.”

History

The twentieth century has been called the Age of Anxiety, but concerns about fear and
anxiety are as old as humanity itself. Although fear has been of interest since ancient times,
anxiety was not fully recognized as a distinct and pervasive human condition until shortly before
the beginning of the present century. It was Freud who first proposed a critical role for anxiety in
personality theory and in the etiology of psychoneurotic and psychosomatic disorders. Anxiety
was the “fundamental phenomenon and the central problem of neurosis” (Freud, 1836, p.85).

Origin

Angst

Anxiety

The term ‘ anxiety ‘ is derived from the Greek word , ‘ angst ‘ which means fear. ( Watson
et.al., 1988)

Levels of anxiety

1. Mild level of anxiety is healthy, at this level, perceptual field is heighten, pupils dilate to
accommodate much light, hearing and smelling intensified, and sense of touch is highly
sensitive. The individual is highly alert and attentive and learning and cognition is in its best
state. This stage improves academic performance. (Cohen , 2008 )

2. Moderate level of anxiety on the other hand is unhealthy, the perceptional field of a person at
this level is narrowed; individuals experiencing this level of anxiety have selective inattention.
They have decreased focus and automatism can be observed as repetitive purposeless movements
such as shaking of the hands and feet, twirling of hair and, tapping of fingers. Academic
performance at this level depends on the individual's ability to control the anxiety and carry out
the assigned task. (Gadye,2018)

3. Severe level of anxiety is characterized by reduced perceptual field and a difficulty in


communication. Gross motor movements, such as pacing are characteristic of people at this
stage. Academic performance at this stage depends on the educator's ability to recognize such
individuals and provide a safe environment for them. Communication should be kept short and
simple since communication is altered. Performance at this stage is reduced since most educators
may not be able to provide such environment for the student.(Cohen , 2008 )

4. Panic level of anxiety is the worst and most severe form of anxiety. Total disruption of
perceptual field is present. It is also characterized by loss of ability to communicate, loss of
rational thought and total loss of conscious thinking. Academic performance at this level is very
poor since the student will be unable to remember exactly what he/she is supposed to do.
(Khemiani et.al.,2012)

Types of anxiety

 Major category

State anxiety

State anxiety reflects the psychological and physiological transient reactions directly
related to adverse situations in a specific moment. (Attwell, 2010)

Trait anxiety

Trait anxiety refers to the stable tendency to attend to, experience, and report negative
emotions such as fears, worries, and anxiety across many situations.( Attwell, 2010)
Conscious anxiety

Conscious anxiety is that which we know we fear. Snakes, heights, germs, a first date, a
big presentation, taking a test, or going to the doctor are all common conscious fears. (Attwell,
2010)

Unconscious anxiety

Unconscious anxiety is that which is beyond our conscious awareness. This anxiety most
often declares itself when someone has a panic attack seemingly out of blue. ( Attwell, 2010)

 Other anxieties

Generalized Anxiety Disorder

People with generalized anxiety disorder (GAD) display excessive anxiety or worry, most
days for at least 6 months, about a number of things such as personal health, work, social
interactions, and everyday routine life circumstances. The fear and anxiety can cause significant
problems in areas of their life, such as social interactions, school, and work.

Generalized anxiety disorder symptoms include:

 Feeling restless, wound-up, or on-edge


 Being easily fatigued
 Having difficulty concentrating; mind going blank
 Being irritable
 Having muscle tension
 Difficulty controlling feelings of worry
 Having sleep problems, such as difficulty falling or staying asleep, restlessness, or unsatisfying
sleep. ( Stahl, S.M, 1996)

Panic Disorder

People with panic disorder have recurrent unexpected panic attacks. Panic attacks are
sudden periods of intense fear that come on quickly and reach their peak within minutes. Attacks
can occur unexpectedly or can be brought on by a trigger, such as a feared object or situation.
During a panic attack, people may experience:

 Heart palpitations, a pounding heartbeat, or an accelerated heartrate


 Sweating
 Trembling or shaking
 Sensations of shortness of breath, smothering, or choking
 Feelings of impending doom
 Feelings of being out of control

People with panic disorder often worry about when the next attack will happen and
actively try to prevent future attacks by avoiding places, situations, or behaviors they associate
with panic attacks. Worry about panic attacks, and the effort spent trying to avoid attacks, cause
significant problems in various areas of the person’s life, including the development of
agoraphobia. ( Schmidt et.al., 2002)

Phobia-related disorders

A phobia is an intense fear of—or aversion to—specific objects or situations. Although it


can be realistic to be anxious in some circumstances, the fear people with phobias feel is out of
proportion to the actual danger caused by the situation or object.

People with a phobia:

 May have an irrational or excessive worry about encountering the feared object or situation
 Take active steps to avoid the feared object or situation
 Experience immediate intense anxiety upon encountering the feared object or situation
 Endure unavoidable objects and situations with intense anxiety
There are several types of phobias and phobia-related disorders:

Specific Phobias (sometimes called simple phobias)

As the name suggests, people who have a specific phobia have an intense fear of, or feel
intense anxiety about, specific types of objects or situations. Some examples of specific phobias
include the fear of:

 Flying
 Heights
 Specific animals, such as spiders, dogs, or snakes
 Receiving injections
 Blood(Clarke ,2011 ).

Social anxiety disorder (previously called social phobia)

People with social anxiety disorder have a general intense fear of, or anxiety toward,
social or performance situations. They worry that actions or behaviors associated with their
anxiety will be negatively evaluated by others, leading them to feel embarrassed. This worry
often causes people with social anxiety to avoid social situations. Social anxiety disorder can
manifest in a range of situations, such as within the workplace or the school environment.(Claeke
, 2011 ).

Agoraphobia

People with agoraphobia have an intense fear of two or more of the following situations:

 Using public transportation


 Being in open spaces
 Being in enclosed spaces
 Standing in line or being in a crowd
 Being outside of the home alone

People with agoraphobia often avoid these situations, in part, because they think being
able to leave might be difficult or impossible in the event they have panic-like reactions or other
embarrassing symptoms. In the most severe form of agoraphobia, an individual can become
housebound. ( Bourne,E.J.,2005)

Separation anxiety disorder

Separation anxiety is often thought of as something that only children deal with;
however, adults can also be diagnosed with separation anxiety disorder. People who have
separation anxiety disorder have fears about being parted from people to whom they are
attached. They often worry that some sort of harm or something untoward will happen to their
attachment figures while they are separated. This fear leads them to avoid being separated from
their attachment figures and to avoid being alone. People with separation anxiety may have
nightmares about being separated from attachment figures or experience physical symptoms
when separation occurs or is anticipated. ( Barlow,D.H.,2002)

Selective mutism

A somewhat rare disorder associated with anxiety is selective mutism. Selective mutism
occurs when people fail to speak in specific social situations despite having normal language
skills. Selective mutism usually occurs before the age of 5 and is often associated with extreme
shyness, fear of social embarrassment, compulsive traits, withdrawal, clinging behavior, and
temper tantrums. People diagnosed with selective mutism are often also diagnosed with other
anxiety disorders. ( Attwell , 2010)

Obsessive – compulsive disorder

Obsessive Compulsive Disorder (OCD) involves unwanted and disturbing thoughts,


images, or urges (obsessions) that intrude into a child/teen’s mind and cause a great deal of
anxiety or discomfort, which the child/teen then tries to reduce by engaging in repetitive
behaviors or mental acts (compulsions). Some examples for OCD habits are:

 Putting the money in denominational order, facing same way in my wallet when
receiving change at the store.
 Buying things in multiples of two even the person is not in need of many number of
things.

 Checking the lock, kitchen, pipes etc.. are shut or not when going out of house.

 Tapping the pencil before every new sentence is starting

 Counting everything that falls under the vision like tress, staircase etc… ( Schuster, 2017)

Post traumatic stress disorder

Post Traumatic Stress Disorder (PTSD) is an anxiety disorder that can develop after
experiencing or witnessing a traumatic event, or learning that a traumatic event has happened to
a loved one. DSM5 defines a traumatic event as exposure to actual or threatened death, serious
injury, or sexual violence. (Herman, J.,1997)

Health Anxiety
Although health anxiety is not a disorder, there are several disorders defined by excessive
anxiety related to somatic or physical symptoms, or having an illness or condition. In adults,
these health worries are excessive, ongoing, and uncontrollable, and often result in frequent visits
to medical professionals and reassurance seeking from loved ones all due to exaggerated fears of
being ill. ( Albom, M., 1997)

Hoarding Disorder (HD)


Individuals with this disorder experience ongoing and significant difficulty getting rid of
possessions regardless of their value; and strong urges to save and/or acquire, often non-
essential, items, that if prevented leads to extreme distress. As a result, living space becomes
severely compromised with extreme clutter. In addition, the individual experiences significant
impairment in social, occupational, and other important areas of functioning. ( Bronson,P.,2002)

Performance anxiety

Any situation where you want to perform at your best and are worried about your ability
to do so can create performance anxiety. It turns out that a person’s mentality is just as important
as their ability. The extreme nervousness experienced before or during participation in an
activity. ( Yali et.al., 1999)

Pregnancy anxiety

A negative emotional state that is tied to worries about “the health and well-being of
one’s baby, the impending childbirth, of hospital and health-care experiences (including one’s
own health and survival in pregnancy), birth and postpartum, and parenting or maternal role”
(Dunkel Schetter, 2011, pp. 534–535).

Sexual anxiety

Sexual anxiety is a fear of intense sexual gratification or sexual success. Avoidance of


sexual activity is one of the most common manifestations of sexual anxiety. This anxiety can
take the form of fear of contracting a sexually transmitted disease, unwanted pregnancy or
feelings of newly discovered defectiveness in the partner. (Freud,A., 1946)

Research and statistical data

Researchers found that anxious individuals find it harder to avoid distractions and take
more time to turn their attention from one task to the next than their less anxious peers. This
makes learning, reading, remembering and writing difficult affecting academic performance.
Since, the anxious individuals perform at a comparable level to the non-anxious ones with a
greater cost in terms of effort or perhaps long term stress; it is believed that students with high
anxiety as well as those with low anxiety will have lower academic performance. Therefore,
those with moderate levels of anxiety will perform the best , maintained that if an individual's
experience is negative, then anxiety level will be higher, leading to lower academic performance.
Consequently, if an individual's experience is positive, then the anxiety level will be lower
leading to higher academic performance. From these investigations, it has been observed that
high and lower levels of anxiety is related to poor academic performance while a moderate level
of anxiety is related to optimum academic performance.

 In addition, according to the World Health Organization (WHO), 1 in 13 globally suffers


from anxiety. The WHO reports that anxiety disorders are the most common mental disorders
worldwide with specific phobia, major depressive disorder and social phobia being the most
common anxiety disorders.
 Approximately 4% of youth aged 13-18 will develop PTSD in adolescence
 Approximately 8% of children and teenagers experience an anxiety disorder with most people
developing symptoms before age 21.
 OCD occurs in 2-3% of children and adults during their lifetime.
 Over the past fifty years, clinical studies of human anxiety have appeared in the psychiatric
and psychoanalytic literature with increasing regularity, but prior to 1950, there was relatively
little research on human anxiety (Spielberger, 1966).
Anxiety and studies
Feeling anxious is sometimes perfectly normal however; people with severe form of
anxiety find it had to control their worries. Their feeling of anxiety is more constant and often
affects their performance or daily life. Many sources of anxiety have been reported for some time
by students of Nursing Science Department which are often times related to long hours of study,
practical work and assignments among others. If a student experiences an increased level of
anxiety, the anxiety may have a negative effect, resulting in decreased learning. These extreme
levels of academic related anxiety may cause some of them to even leave the programme. If
nurse educators can better understand the anxiety levels of students of nursing department, they
will be able to develop curricular and educational interventions to minimize the anxiety levels of
students. Hence, the need to investigate the impact of anxiety on academic performance of
students of the Faculty of Nursing, Niger Delta University, Bayelsa State, Nigeria. (Grillon,
1998).

Theories of anxiety

 Behavioural learning theory


 Classical conditioning

According to behavioral psychologists, "learning" is indicated by a relatively permanent


change in behavior or knowledge. Learning can occur without any intention to learn, and without
a conscious awareness that something has been learned. Any change in behavior suggests the
person has learned a new response to a particular situation. Classical conditioning demonstrated
that people can be trained to produce these same reflexive, responses to a neutral stimulus, called
a "conditioned stimulus" or CS. The CS is a stimulus that would not ordinarily cause the
reflexive response. This learning occurs through a process called paired association. A reflexive
behavioral response can be elicited by pairing an unconditioned stimulus (UCS) with
a conditioned stimulus (CS). Thus, when a UCS and a CS repeatedly occur together, they form a
paired association. (Argot, McEvily, & Reagans, 2003 ).

 Operant conditioning

B.F. Skinner, one of the prominent psychologist of the last century conducted many
researches demonstrating that behavior was influenced not only by what occurred before it (as
in classical conditioning, but also by what occurred afterward. Skinner believed that human
beings (and animals) learn a behavior through a system of rewards and punishments. These
rewards and punishment occur naturally in the external environment. When psychologists use the
word "environment," they are referring to all the external events that are going on around a
person.

In behavioral terms, a reinforcement (reward) refers to anything that causes a behavior to


increase. In contrast, a punishment is something that causes a behavior to decrease. If the
environment rewards a behavior, that behavior is reinforced. This increases the likelihood that a
person will repeat the same behavior in the future. Conversely, if the environment punishes a
particular behavior, this decreases the likelihood the behavior will be repeated. His work resulted
from teaching effective parenting skills to improving employee productivity and satisfaction in
the workplace. (Argot, McEvily, & Reagans, 2003 ).

 Operant conditioning and avoidance learning

Two coping strategies for dealing with anxiety symptoms are


called avoidance and escape. avoidance refers to behaviors that attempt to prevent exposure to a
fear-provoking stimulus. Escape means to quickly exit a fear-provoking situation. In 1947, O.
Hobart Mowrer proposed his two-factor theory of avoidance learning to explain the development
and maintenance of phobias. Mowrer's two-factor theory combined the learning principles of
classical and operant conditioning. Based upon the principles of classical conditioning, it was
assumed that phobias develop as a result of a paired association between a neutral stimulus and
feared stimulus. However, classical learning theory could not explain the continuation of
avoidance and escape behaviors. These behaviors often led to further distress and interference in
a person's life such as: 1) the avoidance of pleasurable activities; 2) the inability to engage in
daily activities and responsibilities; and 3) the inability to maintain interpersonal relationships.
The second stage of Mowrer's model attempted to explain why people felt so compelled to avoid
anxiety-provoking stimuli; or failing that, escape from the stimuli. The answer comes from
Skinner's theory of operant conditioning and the environmental rewards produced by these
coping strategies. Mowers proposed that the avoidance of (or escape from) anxiety-provoking
stimuli resulted in the removal of unpleasant emotions. Thus, avoidance becomes a reward and
reinforces (increases) the behavior of avoidance. (Argot, McEvily, & Reagans, 2003 ).

 Cognitive theory

In the 1950's, a psychologist named Albert Ellis, and a psychiatrist named Aaron Beck,
which became popular cognitive theory. According to cognitive theory, our dysfunctional
thoughts lead to extreme emotions. These extreme emotions in turn, lead to maladaptive
behaviors. Albert Ellis's cognitive therapy is called Rational Emotive Behavior Therapy (REBT).
He believed peoples' intense suffering from negative emotions was caused by their irrational core
beliefs. Core beliefs refer to the basic beliefs people have about themselves and the world around
them. He realized that people's internal thoughts and perceptions had a large influence on their
emotions. He also believed that a more active and directive approach to modify thoughts would
positively influence behavioral change. According to Beck, the way we interpret environmental
events is a function of our core schema. A core schema is a central assumption about oneself,
others, and the world. These assumptions influence our feelings and behavior.

 Psychodynamic theory

In 1890’s Freud didn’t consider anxiety to be related to thoughts or ideas, but he did
observe that it was closely linked to sexuality, defining it as sexual excitation that has been
transformed. Freud’s argument was that when the path to satisfaction is blocked, resulting build-
up of unsatisfied libido takes on a toxic character, finding an outlet in anxiety. His theory of
repression describes how the ideas connected to sexual urges are repelled from consciousness
when they come into conflict with ‘civilized’ social norms. His earlier ‘toxic theory’ of anxiety
as transformed sexual excitation was preserved, but with an important modification: while his
earlier views assumed the cause of anxiety to be external blocks to sexual release, the theory of
repression shifted the emphasis to internal ones or psychological inhibitions. This new
perspective led Freud to a complete reversal of his former position: whereas before he had
posited anxiety as a result of repression, he now understood it as preceding repression and giving
rise to it. (Butler & Mathews , 1983 ).

 Maslow’s hierarchy theory

For Maslow, the goal of any human being is to reach a state of "self-actualization" in
which all their needs are met and a state of contented happiness is achieved. However, these
needs must be met in a particular order. According to Maslow, higher forms of happiness are not
achievable so long as these needs are not met.

 Roll May’s existential psychology

May felt that the absence of an innate moral structure in the universe usually led to
people experience anxiety and distress because their expectations of the universe were simply
not being met. His school of existential psychology is intended to deal with exactly this, the
problems that arise from human consciousness working against the problems inherent in
existence.(Butler & Mathews , 1983 ).

 Carl Roger’s – unconditional positive regard

Carl Rogers was the first to advocate for the importance of "unconditional positive
regard", a way of viewing one's self in which one is unconditionally positive and accepting,
maintaining the right to be critical without being judgmental or overly harsh. (Butler & Mathews
, 1983 )

 Social learning theory

Social learning theory combines cognitive learning theory, which posits that learning is
influenced by psychological factors, and behavioral learning theory, which assumes that learning
is based on responses to environmental stimuli. Psychologist Albert Bandura integrated these
two theories in an approach called social learning theory, and identified four requirements for
learning—observation (environmental), retention (cognitive), reproduction (cognitive),
and motivation (both). Bandura did the famous bobodoll experiment and concluded that children
learn aggression, violence, and other social behaviors through observation learning, or watching
the behaviors of others. (Bailey, 2007)

 Animal model of anxiety

Many animal models of anxiety examine the natural behavioural patterns of mice and rats
to develop ethologically based behavioural tasks (Rodgers et al., 1997). These include
‘approach–avoidance' tasks (Cryan and Holmes, 2005) in which animals are exposed to an
aversive/threatening environment e.g. open, elevated arms of the elevated plus-maze, light arena
(light/dark exploration/emergence tests); and open field tests, with anxiety-like behaviour
(phenotype) in each case, inferred from increased avoidance. Other models include social
interaction tests (review by File and Seth, 2003), punishment-based conflict procedures (e.g.
punished drinking — Vogel et al., 1971), defensive burying tests (Jacobson et al., 2007),
predator stress (Blanchard and Blanchard, 1971), and the examination of ultrasonic vocalizations
induced by stress such as maternal separation (see Sanchez, 2003), while novel techniques
include the use of radiotelemetry to asses a variety of physiological parameters in real time (e.g.
core body temperature, Adriaan Bouwknecht et al., 2007). Such models examine behaviour that
is functionally rather than superficially related to human anxiety (i.e. they show good face
validity) and probe mechanisms derived from theory (possess good construct validity).

Anxiety is an aversive emotional state, in which the feeling of fear is disproportionate to


the nature of the threat. In response to threatening situations, the feeling of the emotion that
constitutes the subjective feature of anxiety is accompanied by emotional stress, which involves
behavioral, expressive and physiological features, such as an avoidance of the source of the
danger, assuming defensive postures and an increase in blood pressure, respectively. Anxiety is a
normal emotional response to a threat or potential threat. When this emotion is inappropriate,
extreme and persistent, it is classified as pathological. (Laborit , 1993 ).

These new techniques, which include the possibility of creating transgenic and knockout
animals to investigate the effects of any known gene, are expected to speed up the molecular
dissection of anxiety and ultimately lead to the design of more efficient anxiolytic drugs.
(Laborit ,1993 )

 Neuro – cognitive model of anxiety

Neurocognitive models of anxiety propose a common amygdala-prefrontal circuitry that


underlies dysfunctional biases in emotion processing e.g. selective attention to threat,
interpretation of ambiguous emotional stimuli and acquisition and extinction of conditioned fear
(Bishop, 2007). There is compelling evidence that clinically anxious adults and children, and
individuals with sub-clinical levels of anxiety, demonstrate a range of biases in emotion
processing; most notably a readiness to selectively attend to threat cues (review by Bar-Haim et
al., 2007; Waters et al., 2008) and to interpret emotionally ambiguous stimuli in a negative
manner (review by Mathews and MacLeod, 2005).

Anxiety and studies

The consequences of anxiety during test or examination may limit the educational or
vocational development and promotion through the educational system. It is normal for a student
to feel anxious before a test or examination, but it becomes problematic when the level of
anxiety is excess. The negative effects of anxiety can be explained by two models namely; the
Interference and the Learning Deficit Models.

According to the interference model, anxious( J. A. Afolayan et al, 2013 ) students are
distracted due to task irrelevant cognitions and negative thoughts during examinations, while the
learning deficit model proposes that it is student’s ineffective study habits during preparation for
an examination that causes them to be anxious .(Bower , Gilligan , Monterio ,1981 ).

Causes of anxiety

An anxiety condition isn't developed or caused by a single factor but a combination of


things. A number of other factors play a role, including personality factors, difficult life
experiences and physical health. ( Attwell, 2010)

Family history of mental health conditions


Some people who experience anxiety conditions may have a genetic predisposition
towards anxiety and these conditions can sometimes run in a family. However, having a parent
or close relative experience anxiety or other mental health condition doesn't mean you'll
automatically develop anxiety.

Personality factors

Research suggests that people with certain personality traits are more likely to have
anxiety. For example, children who are perfectionists, easily flustered, timid, inhibited, lack self-
esteem or want to control everything, sometimes develop anxiety during childhood, adolescence
or as adults.

Ongoing stressful events

Anxiety conditions may develop because of one or more stressful life events. Common triggers
include:

 work stress or job change


 change in living arrangements

 pregnancy and giving birth

 family and relationship problems

 major emotional shock following a stressful or traumatic event

 verbal, sexual, physical or emotional abuse or trauma

 death or loss of a loved one.

Physical health problems

Chronic physical illness can also contribute to anxiety conditions or impact on the treatment
of either the anxiety or the physical illness itself. Common chronic conditions associated with
anxiety conditions include:

 diabetes
 asthma

 hypertension and heart disease

Some physical conditions can mimic anxiety conditions, like an overactive thyroid. It can be
useful to see a doctor and be assessed to determine whether there may be a medical cause for
your feelings of anxiety.

Other mental health conditions

While some people may experience an anxiety condition on its own, others may
experience multiple anxiety conditions, or other mental health conditions. Depression and
anxiety conditions often occur together. It's important to check for and get assistance for all these
conditions at the same time.

Substance use

Some people who experience anxiety may use alcohol or other drugs to help them
manage their condition. In some cases, this may lead to people developing a substance use
problem along with their anxiety condition. Alcohol and substance use can aggravate anxiety
conditions particularly as the effects of the substance wear off. It's important to check for and get
assistance for any substance use conditions at the same time.
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