“You know what, I have figured it out. I can control my occasional anxiety attacks.” A patient in his 30s casually rationalises his state a few days after going through a panic attack.
Everyone feels anxious from time to time. It’s common when one is going for an interview, starting college, or meeting someone for the first time. In fact, anxiety in mild or moderate degree helps in being prepared and enhancing learning and performance. However, it becomes maladaptive when it becomes severe and chronic. One tends to get caught in a vicious circle difficult to break. Then this state of anxiety caused by natural selection as a coping mechanism for humans can turn into anxiety disorder.
Differentiating Fear, Worry, and Stress in the Context of Anxiety Disorders
Humans generally use a couple of similar terms to describe their anxieties like fear and worry. Fear, a basic emotion acts on the amygdala (a small but crucial structure in the brain near the hippocampus involved in processing our emotions and memories related to fear) activating the ‘fight or flight’ response of the sympathetic nervous system. In case of real danger, the body releases hormones to prepare us to adapt to the stimuli causing that fear. Once that situation or stimuli no longer exists, the body returns to the earlier state activating the ‘rest and digest’ mode in the parasympathetic nervous system.
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Worry is generally a temporary preoccupation about something specific in our mind that we are thinking about, for example, after not getting the right house to shift, a couple may worry about not getting one at all. The most loosely used word these days to just describe any situation one is going through is stress. Anxiety is more complex than the above terms. Even though the neurobiological stress response is activated in anxious individuals, they invariably have overactive imaginations, constantly projecting their thoughts into the future that become difficult to control.
According to Diagnostic Statistical Manual (DSM-5, 2013) anxiety disorders (AD) include generalised anxiety disorder (GAD), separation anxiety disorder, selective mutism (SM), specific phobia (animals, height, lifts etc.), social anxiety disorder, panic disorder (PD), and agoraphobia.
The reason you don’t see obsessive-compulsive disorder (OCD) and post-traumatic stress disorder (PTSD) in this list anymore is that they have been put into separate categories since 2013. Our focus in the article is on ADs so without discussing specific diagnostic criteria, let’s briefly just know what they are.
Generalised Anxiety Disorder:
As the name suggests, people with GAD worry excessively about daily life situations such as work & academics. Physical symptoms include being always on edge, tensed muscles, irritability, and difficulty in focusing, concentrating and sleeping. These become so encompassing that there is significant clinical distress and/or impairment in daily and important life areas.
Separation anxiety disorder:
Symbolises excessive, persistent fear about separating from or losing those they are attached to or even harm of any kind befalling them including death. It is so permeable that they refuse to step out of the house.
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Specific phobia:
One of the most common manifestations of anxiety, phobias presents themselves as intense fear and anxiety to specific stimuli such as animals, hospitals, closed spaces, and heights. Individuals completely avoid these objects and situations in the absence of any threat posed by them. Even thinking about these stimuli can cause great uncontrollable anxiety to disrupt the normal functioning of life.
Social anxiety disorder:
earlier called social phobia, individuals with this AD fear extreme anxiety and persistent fear of social situations like meeting new people, giving a presentation or just having a conversation. They may feel debilitating anxiety about being judged in a negative way, ridiculed, or laughed at and made fun of in such social situations that can begin days or even weeks before a particular event.
Panic disorder:
Very common in today’s times, PD is defined by a sudden, abrupt surge of extreme discomfort that reaches its peak in a few minutes. Some physical symptoms of this condition are chest pain or discomfort, heart racing, sweating, nausea, dizziness and trembling, heat sensations (hot flushes) or chills. Negative cognitions associated are thoughts of dying and fear of ‘going up the wall’’. People with PD could also have attacks out of the blue and persistent worry about them reoccurring leads them to avoid and change their behaviour accordingly. It is also commonly associated with agoraphobia where people avoid public places like buses, cinemas or malls to escape anxiety attacks for the fear of not being able to do anything about them if they occur.
Selective Mutism:
Commonly occurring with social anxiety, usually beginning before the age of 5, SM can be defined as an inability to speak or respond appropriately in social situations where children are expected to do so, such as with other kids and adults in school. They however are comfortable in the presence of close family members and have no problems in speech or communication.
There are more than 200 behavioural, emotional and physiological symptoms of anxiety. I have listed some common ones in the inexhaustible list below.
- Persistent negative mood
- Excessive worrying about possible threats
- Avoiding situations that make you feel anxious
- Difficulty in focusing and concentration
- Dizziness
- Muscle tension
- Increased heart rate
- Hyperventilation (rapid breathing)
- Fatigue
- Stomach problems
- Frequent urination
- Sleep difficulties
- Choking/ shortness of breath
- Headaches
- Feeling on the edge/restlessness
- Sweaty palms
- Chest pain
- Trembling
Now, these are distressing, to say the least. Why do we experience these overwhelming and very uncomfortable symptoms when we refuse to seek help?
There is a never-ending debate on the role of genetics and environment on personality formation and how each plays a part in the manifestation of mental health disorders. A recent 2017 review of family and twin studies on GAD and its correlates like pathological worry and neuroticism suggests significant heritability (importance of genes). Another 2016 study implicates specific genes in ADs for example; the NPSRI gene has been linked with PD in women.
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Anxiety Risk Factors
So, if your parents or biological ancestors have or had anxiety and other mental health issues, that can put you at risk, but this is not a causal factor. This also does not mean that you cannot have anxiety without any genetic link. The environment has a significant role to play from your literal geographical condition to childhood experiences, social connections and physical health contributing to a predisposition to anxiety and related conditions.
Have you ever wondered about how someone’s personality i.e. how they deal with life experiences, can impact their mental health? Well, certain personality types may be more prone to anxiety because the kind of person guides you to react or respond to stressors. Originally described as a ‘type A’ personality by cardiologists Friedman and Rosenman (1976), now known as a type A behavioural pattern, those exhibiting competitive, over-ambitious traits find themselves easily stressed. They are never satisfied with what they are doing and are impatient as if time is running out and can’t sit still. They continue to strive for a space or goal that they have defined as success.
Perfectionism, Rumination and Inexpressiveness:
Research has shown a strong correlation between ADs and perfectionism. Individuals with such traits also tend to show hostility and aggression, the former apparently a major factor linked to coronary heart disease. Ruminators or overthinkers keep worrying, analysing the same thoughts, and situations repeatedly and getting caught in a rut are also more prone to anxiety. Inexpressive individuals who keep things to themselves and never express feelings and emotions tend to struggle with anxiety and related disorders. This can be seen in men in many cultures who have been socialised from birth to be ‘strong’ and not cry. Going against nature (releasing stress) causes an increase in the body’s inability to relax and an increase in stress hormones (cortisol).
So, some of the things you will get to hear are: “I’m just worrying too much and will get better in a few days. Everyone gets anxious and it isn’t a big deal. I’ll avoid situations that make me anxious.” Research has proven that avoiding the source of worry can in fact reinforce the thought and prevent you from actually gathering information that will prove otherwise.
“I can talk to my best friend and my family can help.” Family and friends would be concerned and will offer support, but anxiety will not go away just by being reassured. “In case, nothing works, I will take an anti-anxiety pill.”
Also Read: Eco-Anxiety: The Psychological Strain of Climate Change
What are the steps you can take to treat anxiety and ADs?
1) Medication:
Benzodiazepines such as alprazolam, diazepam, and lorazepam are often preferred over other classes of drugs as they are less toxic. These work on gamma-aminobutyric acid (GABA), a neurotransmitter in the brain, producing calming effects on the chemicals that become overactive in anxiety. However, due to their addictive nature, people can become dependent on them producing effects that can become a cause for concern in today’s age. Medication only helps with balancing neurochemicals and patients must see a therapist or a psychologist for the treatment and management of symptoms.
2) Cognitive Behaviour Therapy (CBT):
It would be very easy to tell someone to ‘not worry’ and be positive. But then you won’t be addressing the feelings of fear and anxiety. CBT helps to break or modify thought patterns that are unhelpful and affect our mood, behaviour and physical reactions. It helps the patient to know the difference between useful and unproductive worry. Behaviour therapy, graded exposure therapy, and progressive relaxation techniques are also common strategies employed as a treatment for anxiety
3) Cognitive Bias Modification (CBM):
Anxious individuals pay more attention to threat-related cognitive biases and interpret ambiguous situations negatively instead of positively or neutral. CBM helps in directly modifying these biases, which are not easily accessible and appear to function automatically.
4) Dialectical Behaviour Therapy (DBT):
DBT is a type of CBT that works as an adjunct therapy, whereas traditional CBT may not work for all. It works by helping the patients to accept and acknowledge the experiences and emotions they are going through in the present moment and at the same time motivating them to change. Physical exercises such as aerobics and yoga have for decades proven beneficial for alleviating anxiety.
Research has shown that even a session of acute exercise (a 30-minute walk) can reduce self-reported state and trait anxiety. So stop giving excuses to yourself and others about why you don’t have the time to exercise. New techniques revolving around the body’s energies known as energy techniques include the now comprehensible Simple Energy Techniques (SET) and Emotional Freedom Techniques (EFT).
These are based on the fact that negative emotions and thoughts are a product of an equilibrium or disruption in the body’s energy field. So, these help by interrupting or weakening negatively held beliefs and emotions and people can even feel relaxing effects in a few seconds or minutes. One disclaimer though is that those with severe mental health illness should consult a professional before self-practicing these, as they are not an alternative to therapy and/or medication.
Somatic therapy:
‘Soma’ implies the body so somatic would pertain to anything referring to the body. Somatic therapy focuses on the mind-body connection and involves breathing exercises, body movement strategies and other such methods. One such mode is popularly known as EMDR (eye movement desensitization and reprocessing). Pranayam and Meditation have proven time and again to heal anxiety and other mental health disorders. Apart from the above, eating right, cutting down on caffeine & alcohol and quitting smoking are essential for reducing anxiety and improving overall health.
Getting rid of anxiety is achievable:
The right support from family and loved ones always makes the process easier. Next time when you meet someone who exhibits symptoms and is scared or in denial of accepting their mental health problems suggest steps that they can take to ease their issues and advise them to consult for a mental health professional.
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