4.1 Symptoms, behaviours and negative thoughts
A change in behaviour can often be the presenting symptom of anxiety − a response to physiological or psychological stressors. Common symptoms and general behaviours associated with anxiety disorders are listed in Box 5. Cognitive distortions (negative modes of thinking) that can contribute towards and exacerbate anxiety are summarised in Box 6.
Box 5 Common symptoms and general behaviours associated with anxiety disorders
Physical: trembling, muscle tension, shortness of breath, accelerated heart rate, heart palpitations, sweating, dizziness, dry mouth, loss of appetite, nausea, headaches, insomnia.
Behavioural and cognitive: avoidance, disturbed sleep, procrastination, turning to alcohol, increased caffeine or nicotine use, distractibility, restlessness, irritability, hypervigilance, repetitive thoughts, negative self-talk, disorientation, thoughts of dying or ‘going insane’ or ‘out of control’, persistent worries, difficulty concentrating, experiencing frightening or intrusive thoughts or images.
General behaviours and associated outcomes
Feeling overwhelmed; fear of failure; perfectionism; missed or unmet deadlines; low performance; lost relationships; difficulty relaxing; overwhelming spells of panic; avoiding places or situations from which a quick exit is not possible; feeling as though something catastrophic will happen; further concern or distress about own anxiety (negative circle); significant changes in behaviour as a result of anxiety; avoiding social interaction or situations; feeling judged; feeling embarrassed; experiencing intrusive thoughts or repetitive behaviours; can lead to substance use e.g. alcohol or ‘hard drugs’ such as cocaine, ecstasy, marijuana to cope with anxiety; increased caffeine or nicotine use can further heighten state of ‘arousal’ and hypervigilance.
Box 6 Anxious thinking − cognitive distortions that can contribute to increased anxiety
based on Beck (1964, 1976) and Burns (1980)
All or nothing: seeing things in black and white or right and wrong terms.
Disqualifying positives: rejecting positive experiences because they ‘don’t count’.
Jumping to conclusions: drawing negative conclusions even though there is insufficient evidence.
Mind reading: arbitrarily deciding you know what negative conclusions others have made about you.
Catastrophising: assuming extreme and horrible consequences of events.
Shoulds and shouldn’ts: telling yourself what you ‘should’ and ‘should not’ do.
Mental filtering: focusing on a single negative detail and dwelling on it.