Anxiety is not an enemy: Doctors offer tips on dealing with fears, doubts and worries

While anxiety can be helpful sometimes, it can also be debilitating

From left: Envy, voiced by Ayo Edebiri; Anxiety, voiced by Maya Hawke; and Disgust, voiced by Liza Lapira, in Inside Out 2. Photo: Disney / Pixar

The release of Disney's Inside Out 2 has people talking about mental health, primarily because of a new major character in protagonist Riley's head: Anxiety.

In the first film, released in 2015, Riley, then 11, is guided by five basic emotions through her childhood – Joy, Anger, Sadness, Disgust and Fear. The sequel picks up two years later with Riley entering puberty and a new set of emotions are introduced – Anxiety, Envy, Embarrassment and Ennui.

While the animated films are full of colour, humour and lightheartedness, at the core of the Disney franchise is a demonstration of mental health. The movies employ the assistance of experts like Dacher Keltner, a professor of psychology at the University of California Berkeley, to portray some level of real-life accuracy.

The sequel follows the nine emotions and how they can help 13-year-old Riley form a sense of self.

“What is so important about this film is that it represents the reality that natural functioning involves a whole lot of emotions that are not particularly comfortable, but they are valuable,” Dr Lisa Damour, a clinical psychologist and bestselling author of The Emotional Lives of Teenagers, tells The National.

“They are protective. They are growth-giving. And they all have a place in our lives and are not on their own grounds for concern.”

Joy, voiced by Amy Poehler, and Anxiety, voiced by Maya Hawke, in a scene from Inside Out 2. Photo: Disney / Pixar

Although the film centres on teenage mental health, dealing with anxiety is universal and age agnostic. As humans age, it reveals, they form more complex emotions and learn different tools to deal with them.

According to the World Health Organisation, anxiety disorders affect hundreds of millions of people globally every year. While some level of anxiety is important, as Inside Out 2 suggests, there are people who deal with it in excess – potentially impacting their relationships, careers and daily routines.

How to deal with anxiety

The first step to dealing with anxiety is to detect and recognise it.

Maida Kajevic, a clinical psychologist at German Neuroscience Center in Dubai, says it's important to remember that “anxiety is not an enemy”.

An optimal level of anxiety, she adds, can even help people be more productive – for example, when dealing with work deadlines or presentations. Generally negligible levels of anxiety can be nervousness, nausea or sweating, but they are not debilitating.

When anxiety and its symptoms are deemed controllable, there are many self-help techniques that can be done such as talking about one's feelings, keeping a diary and practising mindfulness, Kajevic says.

“If there's no emergency, it helps to take a step back and think about our feelings, question our thoughts and really understand what is making us feel anxious,” she says.

But anxiety in excess can be problematic, Kajevic says. “Anxiety can affect our behavioural, social and physical functions,” says Kajevic. “On a physiological level, anxiety can manifest in several somatic sensations, such as difficulty breathing, elevated heart rate and dizziness.”

Inside Out follows the nine emotions living inside 13-year-old Riley. Photo: Disney / Pixar

Psychosomatic symptoms include fatigue to abdominal pain, which are often markers of excessive anxiety. “Our brains can hide the truth from ourselves, so we need to listen to our bodies,” she says.

Dr Victoria Mountford, a clinical psychologist at Sage Clinics in Dubai, says "Some signs of a panic attack include racing thoughts, increased heart rate, rapid breathing, feeling hot or sweaty and restlessness or trembling.

"We may also feel something bad is about to happen and have a strong urge to escape the situation."

If experiencing a suspected attack, Mountford recommends doing breathing exercises. "Inhale slowly for four seconds, hold for four seconds and exhale through your mouth for four seconds and repeat," she says.

A grounding exercise can also help in the moment. "For example, they can practice the 3-3-3 technique: name three things that you can see, three things that you can hear and move three body parts," explains Mountford. This mental trick can calm the mind and help bring one back to the present.

Mountford says lifestyle changes can help manage future attacks, such as reducing caffeine, ensuring adequate sleep and generally looking after one's physical health.

“Anxiety is fine as long as we don't let it take control over our decisions and behaviours,” adds Kajevic, "and when it does, it is worth going to a professional for treatment."

Cognitive behavioural therapy or CBT is the most common treatment for people dealing with anxiety. Through expert guidance, exercises and homework, therapists can equip patients with tools to help them gain more control about their feelings and behaviour.

“What we do clinically, is to try to help people recognise their shortcomings, while still holding themselves at a reasonable level of self regard,” says Dr Damour. “Being able to say, 'Yes, I have imperfections, but I'm still a valuable and worthy person,' that's what we're always trying to achieve in our clinical work.”

Medication is also another option, but experts agree it should be considered when therapy and other self-help strategies have been exhausted.

“Don't condemn your emotions, don't give them pharmaceuticals right away. Just listen to them, accept them, engage with them,” says Dacher Keltner, a professor of psychology at the University of California Berkeley.

For teenagers who are transitioning from childhood to adolescence, Arfa Banu Khan, a clinical psychologist at Aster Clinic Bur Dubai, says counseling can "help with early identification and management of potential issues. Early therapy can help parents understand the teen phase and adopt a gentle parenting approach, easing the transition process. It also enables teenagers to understand themselves better and manage their emotions rationally."

How to help someone who is experiencing anxiety

It might be difficult for someone to self-assess when they are the ones dealing with too much stress, so the role of family members and friends can be crucial in this regard.

“If you notice any changes in the general day-to-day functioning of someone significant in your life, encourage them to express their feelings without criticising them,” says Kajevic.

“We already have our inner criticisers, so we don't need an external one,” she adds. It's also important for friends and family members not to cause additional panic when there are physical symptoms of anxiety,” adds Kajevic, and to respect the person in whatever way they want to cope with their anxiety – whether by giving them space if they ask for it, or assistance if they want to pursue professional help.

It helps, says Kajevic, that mental health is more readily discussed by younger generations. “I see younger people being more open to therapy and talking about their feelings,” she adds.