I have always had clients that have come for therapy due to anxiety, however, it seems that due to the pandemic, anxiety seems to be an underlying issue. A lot of it comes from fear, mostly due to fear of the unknown. We are inundated with negative news, how many people have the virus, how many people have died. Are we going to get enough vaccines, when will this end? Many people have been laid off, divorces and separation have risen. Child abuse, spousal abuse and parents balancing working from home and online classes.

According to a poll that was taken prior to the holiday-season in 2020, Canadians reported their highest- ever levels of depression and anxiety. The poll was taken by a charity group, Mental Health Research Canada taken between Dec. 10^th and Dec 18^th, 2020, found that 22 % of Canadians that were surveyed reported that they had been diagnosed with depression and another 20% saying they have received a anxiety disorder diagnosis. Those rates are the highest that MHRC has measured, and 4 % points higher than before the pandemic. Self-reported feelings of anxiety and depression were also found to be at all-time highs.

We have all experienced fear and anxiety. Fear is a universal emotion that signals that we are in impending danger. We all would feel fear, when we lose control of our car on an icy road, or hearing the pilot announce that the landing gear is not working and to prepare for a crash landing, or being attacked by an armed thief. Because of this, fear is a useful emotion.

However, when fear is misdirected, excessive, and disengaged from reality, it no longer gives us an accurate signal of danger. An example of this is if you feared dogs, you may try to avoid all encounters with dogs, although most dogs don’t put anyone in imminent danger just by being dogs.

There is a difference between fear and anxiety. Fear is a basic, automatic response to a specific object, situation, or circumstance that involves a recognition of actual or probable danger.

Anxiety is a much more prolonged and complex emotional state, that is typically triggered by an initial fear. Anxiety is a more enduring experience than fear. It is when a person foresees that some future situation, event, or circumstance that may involve a personally distressing, unpredictable, and uncontrollable threat to their vital interests. You may feel anxious about thinking about an important interview, going to a place where you don’t know people, traveling to an unfamiliar place, your work performance, or a deadline. Anxiety is future oriented; it is driven by “what if?” thinking. We are not anxious about the past, what already has happened; rather, we become anxious over imagined future adverse events or upheavals: “what if my mind goes blank during an exam?”

Fear is at the center of all anxiety states. Fear is the underlying psychological state that drives the anxiety.

TIPS

It may be difficult to identify the core fear that happens when you feel anxious, because most of us focus on the feelings of anxiety more than on what is making us anxious.

You can ask yourself what is so upsetting about this situation? And what is so bad about this situation?

Sometimes the core fear in anxiety is simply fear that you will feel anxious.

When you feel highly anxious, you are affected physically, emotionally, behaviorally and of cognitively.

Here are some of the common effects of anxiety:

Physical symptoms

Increased Heart Rate

Shortness of Breath, rapid breathing

Chest pain or pressure

Choking sensation

Dizziness, light-headedness

Sweating, hot flashes and chills

Nausea, upset stomach.

Trembling, shaking.

Weakness, unsteadiness, faintness

Cognitive symptoms

Fear of losing control, inability to cope.

Fear of physical injury

Fear of negative evaluation by others

Frightening thoughts, images, or memories

Perceptions of unreality or detachment

Narrowing of attention, hypervigilance for threat

Poor memory

Difficulty in reasoning.

Behavioural symptoms

Avoidance of threat cues or situations

Escape, flight

Pursuit of safety

Restlessness, agitation

Freezing, motionless

Difficulty speaking

Emotional Symptoms

Feeling nervous, tense, wound up.

Feeling fearful

Being edgy, jumpy

Being impatient, frustrated

Anxiety State Describe what makes you feel anxious. What situations trigger your anxiety? When are you most likely to feel anxious? What might you do to avoid doing because you are too anxious?	Core Fear Identify the core fear behind your anxiety. What is the worst that could happen in the anxious situation? Is there some catastrophic outcome you fear? What is the threat posed to you or your loved ones?

Think back to an anxiety episode. If you run through the preceding list, can you identify the physical, cognitive, behavioural, and emotional symptoms that occur when you feel anxious?

Tip

It is natural to feel overwhelmed by anxiety Breaking down your anxiety experiences and dealing with each component will make anxiety feel less intimidating. Once you understand the components of your anxiety, you will be ready to apply them to some strategies.

Anxious concern what do you feel anxious about?)	Physical symptoms (when anxious, what physical sensations do you experience?)	Cognitive symptoms (what goes through your mind when you are anxious? What are you thinking about?	Behavioural Symptoms (How do you behave when anxious? What do you do?)	Affective Symptoms (how do you feel when anxious?)
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Because your anxiety is not that bad, may be the reason why you have never addressed it. It can be challenging to judge for yourself, what is normal or abnormal anxiety?. Every time I see a client with anxiety, I need to determine whether the client is suffering from an anxiety disorder, the severity of the anxiety, and the degree of interference in daily living caused by the condition. If your anxiety is severe, it may be important to see a therapist.

Because there is no physical test for anxiety, assessments come from self-reported symptoms, these symptoms often change over time and across situation, and individuals differ on how they tolerate anxiety.

There are specific characteristics that are used to assess a diagnosis of anxiety. How many of these characteristics you have, and to what extent.

Exaggerated intensity. Clinical anxiety tends to be much greater than one would expect in a specific situation.
Persistence. Clinical anxiety tends to persist longer than nonclinical states. Everyone worries from time to time, but people with pathological worry experience it for hours, day in and day out.
Interference. Clinical anxiety tends to interfere with function at work or school, social events, recreation, family relations and other routine activities.
Sudden anxiety or panic. An occasional surge of anxiety or even panic isn’t uncommon, but frequent occurrences may represent an anxiety disorder.
Generalization. In anxiety disorders, the fear and anxiety often spread from a particular object or situation to a broad range of situations, tasks, objects, or people.
Catastrophic thinking. People with clinical anxiety tend to think about worst-case scenarios. Because anxiety always involves the anticipated (the what ifs), the thinking style in anxiety disorders I biased toward assuming that serious threat are mor likely than they actually are.
Avoidance. Most people with anxiety disorders try to eliminate or at least minimize their anxiety by avoiding anything that trigger it. Triggers could be certain situations – crowded stores, meetings, ill people etc. or objects such as bridges, hospitals, certain animals. Extensive avoidance might reduce anxiety in the short term, but it comes at a high cost. It contributes to persistence of the anxiety and reduces a person’s level of daily functioning.

The Anxiety Disorder Checklist

The checklist consists of a series of statements about anxiety. Place a check mark beside the yes or no box. If you find that most of the statements apply to your anxiety, you are experiencing clinically significant anxiety and should seek professional help.

	YES	NO
My anxiety episodes are moderately to severely distressing to me
I am anxious about ordinary, everyday situations or tasks that most people face without difficulty.
I have anxiety episodes daily or at least several times per week
I have had problems with anxiety for several months or even years.
My anxiety episodes last longer than would be expected, given the situation
I avoid certain places, situations, people, or activities because of anxiety.
Anxiety interferes in my work (school), relationships with people and or family relations.
I tend to catastrophize (think the worst outcome) when anxious
I experience sudden onsets of anxiety of panic attacks
My anxiety has spread so it now includes a number of different situations, objects, people, tasks, and so forth
I am not very successful at controlling anxiety without medication.
I have become quite fearful of the anxiety episodes
It is increasingly difficult to feel calm or safe.
Close friends or family members think I have an anxiety problem.
I have always tended to be an anxious person.

I have added Virtual Reality Therapy to my practice. From experience, I have had issues shutting of my mind. You can download the app – Psious VR/Virtual Reality for Mental Health -and choose the Automatic Scenes, the pairing code is for clients that want to be guided in the virtual reality sessions with me. However the Automatic scenes can allow you to do these Focus exercises and Breathing exercises on your own. They are quick, I personally use them when I need to refocus. If you have the google cardboard VR glasses or your own VR googles, even better- if not 2-dimentional also works.