Anxiety and Stress Onboard

Stress is a response to certain situations. As a coping mechanism, it helps us adapt to new environments and circumstances. However, when the exposure to stressors is constant, we start to become distressed. Work – related stress is becoming an increasing concern in many countries. In Greece, people who report job strain reach as far as 43%. The levels of stress that relate to work depend on the nature and the demands of the job and the characteristics of the individual. Work related stress has been associated with health hazards such as cardiovascular diseases and physical injuries caused by strain. Prolonged stress can lead to the development of anxiety and anxiety – related disorders.

Seafarers experience high levels of stress in their job. Seafaring entails dangers that are not present in many other occupations. Seafarers work under threat of injury from accidents and piracy and diseases. Stressors in seafarers can be personal or directly connected to work conditions. Personal stressors are referred to in terms of how satisfied the seafarer is with his or her work, and the self – perceptions associated with their work. Occupational stressors entail the specific adverse conditions and hazards associated with their work, such as the work being overly strenuous or repetitive, the physical risks associated with their post, their career prospects, employment and compensation and the separation from their loved ones. While experiencing stress, the seafarer’s decision making skills are negatively affected, which is something that increases the risk for accidents and makes them less productive. High stress can also lead seafarers to experience job fatigue, or “burnout”. Burnout is described as mental, emotional and physical exhaustion related to the individual’s work. As we mentioned above, high and constant levels of stress can lead to anxiety and, alongside specific factors, it can lead in the development of anxiety disorders. This does not mean that seafarers experiencing stress and anxiety will develop an anxiety disorder but, if the associated genetic or personal factors are present with stressors, it may lead to one.

What are anxiety disorders?

Anxiety disorders, despite their several types and differences, share the overall characteristic of prevalent anxiety and fear. Fear is a reaction to the specific situation while anxiety is a response to contemplation of future exposure with a specific situation. Panic attacks are a common characteristic of this type of disorders. Anxiety disorders affect approximately 10% of individuals in European countries and 7% of Americans.

General symptoms related to anxiety disorders are:

Feeling fearful, panicked or uneasy.
Difficulty sleeping.
Heart palpitations.
Hands and feet feeling cold or sweaty.
Inability to sit still or calm down.
Shortness of breath.
Hands and feet feeling numb or tingly.
Dry mouth.

Below we will examine anxiety disorders that may pertain to the work and life circumstances of seafarers.

Separation Anxiety Disorder

Separation Anxiety Disorder is defined as excessive fear and worry regarding separation from l

oved ones. For children, it tends to be about their parents while for adults it tends to be about their spouse and children. Separation Anxiety Disorder is diagnosed if combinations of the following symptoms are reported to occur persistently for 6 months or more in adults, if they cause significant distress or impairment in social and professional functioning and if they are not better explained by another disorder.

Recurrent but excessive distress when thinking about or experiencing separation from loved ones.
Persistent and excessive worry about losing loved ones or having harm come to loved ones.
Persistent and excessive worry about experiencing an event, such as accident or illness that will result in separation from loved ones.
Persistent fear or refusal to leave home due to being afraid of separation from loved ones.
Persistent and excessive fear of being alone away from loved ones.
Persistent reluctance or refusal to sleep while not being near loved ones.
Repeated nightmares revolving around separation from loved ones.
Repeatedly complaining about physical symptoms when being separated from loved ones.

Separation anxiety often develops after major life events that separate the individual from his or her loved ones or events that led to the loss of a loved one. As seafarers can spend several months at a time away from home, it is possible for circumstances to lead to Separation Anxiety Disorder or for them to show some of the symptoms.

Specific Phobia Disorder

Specific Phobia Disorder is defined as excessive fear or anxiety regarding a specific object or circumstance. It is diagnosed if combinations of the following symptoms are reported to occur persistently for 6 months or more in adults, if they cause significant distress or impairment in social and professional functioning and if they are not better explained by another disorder.

The phobic object or situation always results in immediate fear or anxiety.
The phobic object or situation is avoided actively or, if endured, it is endured with presenting fear or anxiety.
The fear or anxiety is disproportionately excessive in regards to how dangerous the object or situation actually is.

Specific Phobia Disorder often results from negative or traumatic experiences with the phobic object or situation although other factors such as temperament, parental over protectiveness and loss or abuse tend to factor in the development of the disorder. As seafarers can experience negative and traumatic events while at sea such as injury or piracy attacks, it is possible for them to develop phobias related to these events and their work.

Generalized Anxiety Disorder

Generalized Anxiety Disorder is the most common anxiety disorder. It is diagnosed if combinations of the following symptoms are reported to occur persistently for 6 months or more in adults, if they cause significant distress or impairment in social and professional functioning and if they are not better explained by another disorder.

Generalized Anxiety Disorders defining symptom is excessive anxiety and worry that occurs most days and is difficult to control. It also has to be accompanied by at least three of the 6 following symptoms:

Restlessness or feeling on edge.
Getting tired easily.
Difficulty concentrating or being absent minded.
Irritability.
Muscle tension.
Disturbances in sleep.

Although there are early behavioral and parental issues that correlate with Generalized Anxiety Disorder, it is difficult to identify specific environmental conditions that cause the disorder, as it is very broad, although there is a genetic factor. Seafarers are at risk for Generalized Anxiety Disorder as is the rest of the population and stressors that pertain to their work may lead to it.

When looking at anxiety disorders, it is important to understand that not all the symptoms mentioned above need to be present to diagnose someone with an anxiety disorder. When examining the symptoms, the focus shouldn’t be one – sided but on deviations from the norm. So, if you suspect that you or someone close to you may suffer from an anxiety disorder, don’t look at the individual behaviors but, instead, look at what has changed.

Before assuming that an individual suffers from an anxiety disorder, it has to be taken into account that symptoms of anxiety can occur naturally in life at times of high pressure or transition or be the result of substance abuse, which is why the symptoms need to be present for at least 6 months before looking for a diagnosis. In cases of substance abuse it has to be examined if the individual is experiencing anxiety as a response to a substance or due to withdrawal or if he / she is using to cope with anxiety. Finally, lesser severity in the symptoms, may not indicate to a disorder but to persistent anxiety which still needs to be dealt with.

These distinctions are important so it is crucial to turn to a licensed mental health professional before assuming that you or someone close to you suffers from depression.

Comorbidity of anxiety with depression.

It is common for comorbidity, defined as two disorders occurring at the same time, to exist between psychological disorders. Depression can be co-morbid with anxiety and vice versa, since many of the factors that cause anxiety disorders, such as high levels of pressure, exhaustion, separation from loved ones, etc. can also be causes for depression. Additionally, dealing with the symptoms of anxiety disorders can make the individual feel depressed and vice versa. This is important to note in treatment, since both the symptoms of anxiety and depression need to be addressed properly to better ensure the well – being of the individual.

Treatment

Although there are pharmaceutical treatment options, namely anxiolytic medications, the most effective treatment for anxiety disorders is therapy. This is because therapy can not only treat the anxiety symptoms but also address the causes behind them. That being said, medication can still be useful to help mediate the symptoms in extreme cases.

The most effective treatment for anxiety disorders is Cognitive – Behavioral Therapy (CBT) and Exposure Therapy. CBT involves identifying, challenging and replacing negative thoughts with realistic ones, recognizing symptoms, learning coping skills and confronting fears while Exposure Therapy involves systematically getting desensitized to fears through exposure to them.

Helping Seafarers

Aside from the standard anxiety treatments, steps can be taken to ensure the wellbeing of seafarers. Better pay and job security, as well as less time away from their families can reduce anxiety. Reducing working hours and ensuring rest, improving the occupational conditions by doing whatever possible to minimize accidents and having more accessible first aid, and reducing the time spent at sea can help improve both the physical and psychological wellbeing of seafarers, including anxiety. Anxiety can also be handled by the seafarer on board by taking time to relax, meditate, exercise and sleep and eat well.