WORDS HANNAH MAY-LEE WONG

A psychiatrist and mindfulness-based therapist expands on the topic of anxiety, a crippling yet common mental health issue. He also explains how Acceptance and Commitment Therapy (ACT) can work as a treatment option for those with anxiety disorder.

How would you define anxiety disorder?
Anxiety symptoms are part and parcel of life. For example, it’s normal to feel anxious when you have a deadline for an assignment approaching. Having anxiety disorder on the other hand, means to have anxiety symptoms (fears, worries, and psychosomatic symptoms) that are more intense and frequent, to the extent that it interferes with a person’s daily activities such as job performance, school work, and relationships.

What are the more common causes of anxiety disorder?
The common mental disorders under the anxiety category that I encounter in my adult psychiatric clinic are: panic disorder, agoraphobia, generalized anxiety disorder, and social anxiety disorder. It’s also common for anxiety to occur with depression. The causes of these are multifactorial— it could be biological (caused by hormonal disorders such as thyroid problems, or stress from a physical illness like cancer); psychological (such as traumatic childhood experiences, stressful life events like unemployment, etc.); environmental (natural disasters, haze), or social (political instability such as riots or demonstrations that are prolonged).

Can anxiety disorder run in the family?
If yes, does this mean that there is a genetic component to the disorder? Yes, that’s one of the biological causes of anxiety disorder. I have a strong family history of anxiety disorders. I know the condition inside out. The genetic risk factor partly contributes to my particular interest in anxiety education and treatment.

When should someone with a possible anxiety disorder see a mental health professional?
Someone with a possible anxiety disorder should see a health professional when:

• It interferes with his or her daily activity at school, work, or home.
• He or she makes excessive or unnecessary visits to doctors due to psychosomatic symptoms (a physical illness or other bodily conditions caused or aggravated by a mental factor) or is frequently absent from work due to poor physical health.
• The anxiety leads to depression symptoms such as: loss of interest in daily activities; feeling hopeless or helpless; experiencing changes in sleep, appetite, or weight patterns; having irrational guilt, anger or irritability; or having suicidal thoughts.
• Loved ones can’t tolerate the negativity of the person with anxiety disorder, giving rise to interpersonal challenges eg, marital and parenting issues.
• A person copes with anxiety using unhealthy or harmful methods eg, excessive alcohol consumption, illicit drug abuse, self-harm, or binge eating.

What could happen if the disorder is not properly controlled or treated?
The following complications could occur:

• The affected person could continue to have frequent psychosomatic complaints which could lead to excessive use of medical services—these people tend to “doctor shop”. Due to their weakened immunity, they are also more prone to getting various physical illnesses.
• The person could develop other anxiety disorders (eg, generalized anxiety disorder combined with panic attacks and social anxiety), depression, or suicidal thoughts.
• The person could also turn to alcohol or substance abuse. It can also lead to behavioural addictions like gambling, pornography, or computer gaming addictions.

What is Acceptance and Commitment Therapy(ACT)?
Acceptance and Commitment Therapy (ACT, typically pronounced as the word ‘act’) is an action-oriented and scientifically supported approach to psychotherapy for conditions such as anxiety disorders, major depressive disorder, and substance-use disorders.

Please tell us more about ACT.
ACT teaches various mindfulness and acceptance-based skills (such as present moment awareness, thought defusion, emotional acceptance, and observing mind) in therapy sessions. These methods are intended to help people befriend anxiety symptoms rather than fight or feel bad about them. ACT also uses a set of exercises that help patients identify and commit to their meaningful goals and values in life.

What is the goal of ACT?
To act towards our value-based goals. In ACT, we don’t aim to get rid of anxiety symptoms (such as panic attacks); it’s to embrace anxiety and move towards meaningful goals in life.

Aside from ACT, what other common therapies are recommended for anxiety disorders?

• Cognitive Behavioural Therapy (CBT) eg, challenging thoughts, exposure therapy, and social skills training.
• Antidepressant and anti-anxiety medications may be prescribed by a qualified doctor.
• Relaxation training eg, progressive muscle relaxation, pleasant imagery, and deep breathing. • Emotional Freedom Technique (EFT).
• Eye Movement Desensitization and Reprocessing (EMDR).
• Exercise, meditation, hypnosis, and prayer.

Can one’s anxiety disorder truly go away?
It’s normal to have some anxiety in daily life. It’s also not uncommon that anxiety disorder does not truly go away. Therefore, the aim of ACT is not to eliminate anxiety. It’s to learn to cope with anxiety and move on with life to achieve what is meaningful to us.

What is your advice to people who decide to self-diagnose and “DIY” their own ACT using information found online or in a book?
If it works well for you, good; if not, get guidance from a mental health professional who is familiar with ACT. There is no one-sizefits-all or best treatment plan. Most importantly, do not give up; explore with a therapist on methods or combinations of treatments that suit you. HT