Anxiety | Mate māharahara

Key points about anxiety

  • Anxiety (mate māharahara) is a normal human emotion.
  • If it is so strong that it interferes with you being able to carry out your normal day-to-day life, it is considered to be an anxiety disorder.
  • Anxiety disorders range from generalised anxiety disorder through to panic disorder, agoraphobia, and others.
  •  Approximately 1 in 4 New Zealanders will be affected by an anxiety disorder at some stage in their lives.
  • There are things you can do to manage and even overcome an anxiety disorder. 
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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:

  • separation anxiety disorder
  • selective mutism (not speaking)
  • specific phobia (spiders, heights, flying, receiving an injection, etc)
  • social anxiety disorder (social phobia)
  • panic disorder
  • 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.

Anxiety self-assessment

You can take a test to assess your anxiety. The test is also available in multiple languages(external link)(external link). 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.

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:

  • restlessness
  • a sense of dread
  • feeling constantly "on edge" or irritable
  • difficulty concentrating
  • impatience
  • being easily distracted
  • dizziness
  • irregular heartbeat (palpitations)
  • dry mouth or excessive sweating
  • shortness of breath
  • nausea and or stomach ache
  • a headache
  • poor sleep
  • 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

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. 

Medication

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 SSRIsand 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:

  • understanding anxiety
  • 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
  • learning mindfulness
  • taking good care of your self each day
  • dealing with issues that need addressing 
  • getting personal and professional support.

Read about anxiety apps and e-learning programmes.

Apps reviewed by Healthify

You may find it useful to look at some anxiety management apps, depression apps, mental health and wellbeing - CBT apps, mental health and wellbeing - goal setting, problem solving and motivation apps and mental health and wellbeing - meditation and mindfulness apps.

Instead of anxiety controlling you and what you do, you can take charge. Things you can do to manage or overcome anxiety include:

  • understand anxiety
  • accept that some anxiety is normal and necessary, while also recognising when it becomes unhelpful
  • take small steps towards doing the things you worry about coping with, instead of avoiding them
  • learn mindfulness
  • take good care of your self each day
  • deal with issues that need addressing 
  • get personal and professional support.

Understand anxiety

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.

Check out the apps and e-learning websites that have been reviewed and recommended by Healthify.

Accept normal 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.

Learn mindfulness

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. 

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.  

See also:

Get support 

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:

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.

Exercise

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.

Diet

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 food. Find out more about healthy eating basics.

Sleep

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.

Relaxation

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. 

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.

Support

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.

Video: Box breathing tutorial

Box Breathing is a popular and powerful strategy to reduce stress and anxiety. This video may take a few moments to load.

(Anxiety NZ, 2020)

Video: Relaxation - Breathing Techniques

This video explains why we need to relax and what mechanisms we can use to relax in stressful situations. This video may take a few moments to load.

(Coventry and Warwickshire Partnership NHS Trust, UK, 2013)

Video: Four calming breathing exercises

This video guides you through four calming breathing exercises, to prepare you for the day ahead. The exercises are based on the ancient pranayama yoga practice of controlling your breath and can help reduce stress and anxiety. This video may take a few moments to load.

(Bupa Health UK, 2021)

Video: Headspace | Mini meditation | Breathe

This video guides you through a short meditation. This video may take a few moments to load.

(Headspace U2, 2018)

Video: Equal Breathing Exercise for Sleep

Prepare your body and mind for sleep with this breathing exercise to calm your nervous system. This video may take a few moments to load.

(Fitbit, US, 2020)

The videos below address themes within the Te Whare Tapa Whā model, offering a biopsychosocial approach to managing after disaster or times of significant change. The series references clinical and research-based evidence for the techniques discussed and grounds the information in family experiences from the quakes in Canterbury.

Video: Making Everything Alright - Psychological support

The first film in the series is directed at families or professionals working with families, and looks at psychological ways to manage the two main types of anxiety responses that have shown up in post-disaster populations. This video may take a few moments to load.

(The Worry Bug – Kōtuku Creative, NZ, 2018)

Video: Making Everything Alright – Physical and spiritual support

The second film looks at using spiritual and self-care techniques as part of your everyday life in order to promote mental health. This video may take a few moments to load.

(The Worry Bug – Kōtuku Creative, NZ, 2018)

Video: Making Everything Alright – Community support

The third film examines how community on a wider scale can affect mental health post-disaster. This video may take a few moments to load.

(The Worry Bug – Kōtuku Creative, NZ, 2018)

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:

Watch and listen to these books for children on emotions associated with anxiety.

Video: Aroha's Way – A children's guide through emotions

This video may take a few moments to load.

(Wildling Books, NZ, 2020)

Video: I Feel Anxious by Aleks Harrison | Children's Book About Overcoming Anxiety

This video may take a few moments to load.

(Aleks Harrison, 2022)

Video: How To Tame My Anxiety Monster

This video may take a few moments to load.

(Melanie Hawkins, 2020)

Calm your mind(external link)(external link) Small Steps, NZ
Te Hikuwai resources for wellbeing – anxiety/manawapā(external link)(external link) Te Pou, NZ
Te Hikuwai resources for wellbeing – relaxation/mauri tau(external link)(external link) Te Pou, NZ
Anxiety(external link)(external link) depression.org.nz
Anxiety NZ Trust(external link)(external link)
Anxiety(external link)(external link) The Lowdown, NZ
Anxiety(external link)(external link) Mental Health Foundation, NZ
CALM website(external link)(external link) The University of Auckland, NZ
Find out how to tell if someone is struggling with their mental health(external link)(external link) BBC, UK, 2021
Anxiety self-help resources(external link)(external link) Centre for Clinical Interventions, Australia
Anxiety(external link)(external link) Health Translations Directory, Australia
What is anxiety and the effects on mental health(external link)(external link) Headspace, Australia
Generalised anxiety disorder in adults(external link)(external link) NHS Choices, UK, 2018
How dogs can help with mental health – mind boosting benefits of dog ownership(external link)(external link) UK, 2018
The Big Feels Club(external link)(external link) Articles and podcasts about life + feelings
Mental Wealth(external link)(external link) NZ
Just a thought(external link)(external link) NZ
Anxiety(external link)(external link) Fresh Mind, NZ
Togetherall(external link)(external link) UK

Apps 

Anxiety management apps
Depression apps
Mental health and wellbeing - CBT apps
Mental health and wellbeing - goal setting, problem solving and motivation apps
Mental health and wellbeing - meditation and mindfulness apps

Resources – NZ

Perinatal OCD – new baby, distressing repetitive thoughts(external link) Perinatal Anxiety and Depression Aotearoa, NZ
Anxiety disorders – your guide(external link) The Royal New Zealand College of Psychiatrists, 2017
Anxiety and how to manage it(external link) Mental Health Foundation, NZ, 2021
Refuelling the tank – fuel in, fuel out(external link) Mental Health Foundation, NZ
Finding balance – Te whare tapa whā(external link) Mental Health Foundation, NZ
Identifying your challenges and practising balanced thinking(external link) Mental Health Foundation, NZ
Switching on your relaxation response(external link) Mental Health Foundation, NZ
Anxiety(external link) The Mental Wealth Project, NZ English(external link), te reo Maori(external link), Samoan(external link), Tongan(external link)
There is a way through(external link) Health Promotion Agency, NZ, 2021
Help for the tough times(external link) Health Promotion Agency, NZ, 2016
Talking therapies for Pasifika peoples [PDF, 3.1 MB](external link) Te Pou, NZ, 2010
Talking therapies for Asian people [PDF, 3.1 MB](external link) Te Pou, NZ, 2010
He rongoā kei te kōrero – talking therapies for Māori(external link) Te Pou, NZ, 2010
A guide to talking therapies in NZ [PDF, 564 KB](external link) Te Pou, NZ, 2009

Resources – overseas

Note: The resources below are from overseas so some details may be different in New Zealand, eg, phone 111 for emergencies or, if it’s not an emergency, freephone Healthline 0800 611 116.

What is mindfulness?(external link) Centre for Clinical Interventions, Australia
Talking mental health with young people at secondary school(external link) Anna Freud National Centre for Children & Families, UK
Mindfulness and letting go(external link) Centre for Clinical Interventions, Australia
Living with anxiety – understanding the role and impact of anxiety in our lives(external link) Mental Health Foundation, UK, 2014
The vicious cycle of anxiety(external link) Centre for Clinical Interventions, Australia
What is anxiety?(external link) Centre for Clinical Interventions, Australia
Range of mental health topics in over 20 languages(external link) Royal College of Psychiatrists
Learn about anxiety disorders(external link) Mental Health Association, Canada English(external link), Japanese(external link)
Anxiety in multiple languages(external link) Health Translations, Australia
Simple steps to calm your emotions(external link) This Way Up, New South Wales Multicultural Health Communication Service,  Australia English(external link), Arabic(external link), Chinese (simplified)(external link), Chinese (traditional)(external link), Filipino(external link), Greek(external link), Hindi(external link), Italian(external link), Korean(external link), Spanish(external link), Vietnamese(external link)
Effective ways to express yourself(external link) This Way Up, New South Wales Multicultural Health Communication Service,  Australia English(external link), Arabic(external link), Chinese (simplified)(external link), Chinese (traditional)(external link), Filipino(external link), Greek(external link), Hindi(external link), Italian(external link), Korean(external link), Spanish(external link), Vietnamese(external link)
Five helpful steps for tackling  your problems(external link) This Way Up, New South Wales Multicultural Health Communication Service,  Australia English(external link), Arabic(external link), Chinese (simplified)(external link), Chinese (traditional)(external link), Filipino(external link), Greek(external link), Hindi(external link), Italian(external link)Korean(external link), Spanish(external link), Vietnamese(external link)

Online self-help programmes and courses

There are also online resources designed to help you manage depression and anxiety. Some are free, some have a cost and some require a prescription from your doctor. 

References

  1. Te rau hinengaro – the NZ mental health survey(external link)(external link) Ministry of Health, NZ, 2006
  2. How does anxiety affect sleep?(external link)(external link) National Sleep Foundation, US 
  3. Royal Australian and New Zealand College of Psychiatrists clinical practice guidelines for the treatment of panic disorder, social anxiety disorder and generalised anxiety disorder(external link)(external link) 2018

Clinical pathways and tools

Protecting and promoting mental wellbeing – beyond COVID-19(external link) The University of Auckland, The Centre for Informed Futures, NZ, 2020
Royal Australian and New Zealand College of Psychiatrists clinical practice guidelines for the treatment of panic disorder, social anxiety disorder and generalised anxiety disorder(external link) 2018
Guidelines – supporting young people with stress, anxiety and/or depression(external link) 
Ministry of Social Development, NZ, 2015
Generalised anxiety disorder in adults – diagnosis and management(external link) BPAC, NZ, 2009
Mental health assessment tools(external link) BPAC, NZ
The psychological toolkit(external link) Black Dog Institute, Australia
Carpenter JK, Andrews LA, Witcraft SM, Powers MB, Smits JAJ, Hofmann, SG. Cognitive behavioral therapy for anxiety and related disorders – a meta-analysis of randomized placebo-controlled trials(external link) Wiley Online. 2018 Jan 20. 
Generalised anxiety and mindfulness information sheets(external link) Centre for Clinical Interventions, Australia
Collaborative mental health and addictions credentialing programme - information for GPs and practice managers [PDF, 439 KB] Collaborative Care NZ

Sensory modulation(external link) Counties Manukau Health, NZ
Primary mental health – brief interventions(external link) Te Pou, NZ
Te Hikuwai – resources for wellbeing(external link) Te Pou, NZ

See our page Long-term conditions for healthcare providers

Continuing medical education

Stress, anxiety and depression new approaches to diagnosis and treatment(external link) (Goodfellow Unit Webinar, NZ, 2020)

Videos

In this series of 5 short videos, Karen Fraser explains what healthier breathing is and how it can be used to help clients with anxiety and panic.

Apps 

Anxiety management apps
Depression apps
Mental health and wellbeing - CBT apps
Mental health and wellbeing - goal setting, problem solving and motivation apps
Mental health and wellbeing - meditation and mindfulness apps

Brochures

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Credits: Healthify editorial team. Healthify is brought to you by Health Navigator Charitable Trust.

Reviewed by: Mieke Garrett, Clinical Psychologist

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