Anxiety spans a spectrum from normal adaptive responses to debilitating disorders that impair quality of life. Recognising the cognitive, physical, and behavioural manifestations of anxiety is crucial for timely intervention.

Types of Anxiety Disorders

• Generalised Anxiety Disorder (GAD): Excessive worry about multiple life domains for at least six months, accompanied by symptoms like restlessness, fatigue, and sleep disturbance
• Panic Disorder: Recurrent, unexpected panic attacks—intense surges of fear reaching peak within minutes—often followed by concern about future attacks
• Social Anxiety Disorder: Marked fear or avoidance of social situations due to worries about negative evaluation by others
• Specific Phobias: Intense fear of a specific object or situation (e.g., heights, animals) that is disproportionate to the actual threat
• Other Forms: Includes separation anxiety, agoraphobia, and illness anxiety disorder (hypochondriasis)

Core Symptoms

• Persistent excessive worry and fear
• Restlessness or feeling on edge
• Difficulty concentrating
• Sleep disturbances
• Muscle tension
• Increased heart rate and breathing
• Avoidance behaviors
• Physical symptoms (sweating, trembling, nausea)

Treatment and Management

Psychotherapy

• Cognitive Behavioural Therapy (CBT): Focuses on restructuring maladaptive thoughts and gradual exposure to feared situations, demonstrating strong efficacy across anxiety disorders
• Exposure Therapy: Systematic, controlled exposure to anxiety triggers to reduce avoidance and fear responses

Types of Depression

• Major Depressive Disorder (MDD): Characterized by one or more major depressive episodes without a history of manic or hypomanic episodes
• Persistent Depressive Disorder (Dysthymia): Chronic, less severe depression lasting ≥ two years in adults
• Premenstrual Dysphoric Disorder: Severe mood symptoms tied to the menstrual cycle
• Disruptive Mood Dysregulation Disorder: Severe irritability and frequent temper outbursts in children and adolescents
• Seasonal Affective Disorder (SAD): Depressive episodes occurring seasonally, typically in fall/winter
• Depressive Disorder Due to a Medical Condition: Mood disturbance directly attributable to a physiological effect of a medical condition

Core Symptoms

• Persistent Sadness or Hopelessness: Feeling down, empty, or tearful most of the day
• Loss of Interest or Pleasure: Markedly reduced enjoyment in almost all activities once found pleasurable
• Changes in Appetite or Weight: Significant weight loss when not dieting, weight gain, or decrease/increase in appetite
• Sleep Disturbances: Insomnia or hypersomnia nearly every day
• Psychomotor Agitation: Noticeable restlessness or slowed speech and movements
• Fatigue or Loss of Energy: Feeling tired nearly every day, even after adequate rest
• Feelings of Worthlessness or Excessive Guilt: Persistent or inappropriate guilt about failures or self-blame
• Difficulty Concentrating: Indecisiveness or diminished ability to think and concentrate
• Recurrent Thoughts of Death or Suicide: Suicidal ideation, planning, or attempts

Treatment and Management

Psychotherapy: Cognitive Behavioural Therapy (CBT), Exposure therapy

Psychological trauma refers to the emotional and physiological response that occurs when an individual experiences or witnesses an event perceived as extremely threatening or overwhelming, exceeding their ability to cope and integrate the resulting emotions and experiences

Trauma types and characteristics

• Acute Trauma: Results from a single incident, such as an accident or natural disaster, producing a sudden overwhelming of coping capacity
• Chronic Trauma: Involves repeated or prolonged exposure (e.g., ongoing domestic violence), leading to cumulative stress and complex symptomatology
• Developmental (Complex) Trauma: Occurs during critical developmental periods, often involving interpersonal violations like childhood abuse, and can disrupt attachment, self-regulation, and identity formation
• Post-Traumatic Stress Disorder (PTSD): Exposure leading to persistent re-experiencing of the event, affecting thoughts, mood, and behaviour

Core Symptoms

• Intrusive memories or flashbacks
• Nightmares related to the traumatic event
• Emotional numbness or detachment
• Avoidance of trauma reminders
• Hypervigilance (being on constant alert)
• Exaggerated startle response
• Difficulty sleeping or concentrating
• Negative changes in mood and thinking patterns

Therapeutic Approaches

• Trauma-Focused Cognitive Behavioural Therapy (TF-CBT): Combines cognitive restructuring with graded exposure to trauma memories, delivered in a structured format, often involving caregivers for youth
• Somatic and Body-Based Therapies: Focus on restoring the mind-body connection through interventions like somatic experiencing and sensorimotor psychotherapy, which help release trauma stored in the body
• Narrative and Exposure Therapies: Encourage clients to construct coherent trauma narratives and gradually confront avoided memories or situations, reducing fear and avoidance responses over time