anxiety

Anxiety is often described as having cognitive, somatic, emotional, and behavioral components (Seligman, Walker & Rosenhan, 2001). The cognitive component entails expectation of a diffuse and uncertain danger. Somatically the body prepares the organism to deal with threat (known as an emergency reaction); blood pressure and heart rate are increased, sweating is increased, bloodflow to the major muscle groups is increased, and immune and digestive system functions are inhibited. Externally, somatic signs of anxiety may include pale skin, sweating, trembling, and pupillary dilation. Emotionally, anxiety causes a sense of dread or panic and physically causes nausea, and chills. Behaviorally, both voluntary and involuntary behaviors may arise directed at escaping or avoiding the source of anxiety. These behaviors are frequent and often maladaptive, being most extreme in anxiety disorders. However, anxiety is not always pathological or maladaptive: it is a common emotion along with fear, anger, sadness, and happiness, and it has a very important function in relation to survival.

Neural circuitry involving the amygdala and hippocampus is thought to underlie anxiety (Rosen & Schulkin, 1998). When confronted with unpleasant and potentially harmful stimuli such as foul odors or tastes, PET-scans show increased bloodflow in the amygdala (Zald & Pardo, 1997; Zald, Hagen & Pardo, 2002). In these studies, the participants also reported moderate anxiety. This might indicate that anxiety is a protective mechanism designed to prevent the organism from engaging in potentially harmful behaviors such as feeding on rotten food.

Anxiety Disorders

Main article: Anxiety Disorder

A chronically recurring case of anxiety that has a serious effect on a person's life may be clinically diagnosed as an anxiety disorder. The most common are generalized anxiety disorder, panic disorder, social anxiety disorder, phobias, obsessive-compulsive disorder, and post-traumatic stress disorder (PTSD).

Treatment of anxiety

Prescription medication

The acute symptoms of anxiety are most often controlled with anxiolytic agents such as benzodiazepines. Diazepam (valium) was one of the first such drugs. Today there are a wide range of anti-anxiety agents that are based on benzodiazepines, although only two have been approved for panic attacks, Klonopin and Xanax. All benzodiazepines may induce dependency, and extended use should be carefully monitored by a physician, preferably a psychiatrist. It is very important that once placed on a regimen of regular benzodiazepine use, the user should not abruptly discontinue the medication.

Some of the SSRIs (selective serotonin reuptake inhibitors) have been used with varying degrees of success to treat patients with chronic anxiety, the best results seen with those who exhibit symptoms of clinical depression and non-specific anxiety or general anxiety disorder concurrently. Beta blockers are also sometimes used to treat the somatic symptoms associated with anxiety, especially the shakiness of "stage fright."

Some scientists believe that the benzodiazepines and other antianxiety drugs are greatly overprescribed and potentially addictive.^{citation needed]} The addicitive nature of the benzodiazepine class became apparent in the mid 1960's when Valium (Diazepam), the first drug in the class to win FDA approval, resulted in thousands of people who quickly showed the classic symptoms of addiction when used for more than a week or two consistently.^{citation needed]} However , other scientific research indicates that "the vast majority of the use of benzodiazepines is appropriate"^[1]

The most addictive of the benzodiazepines appears to be Xanax due to its rapid onset and short half life in the blood stream. Xanax also has the dubious distinction of being the only benzodiazepine that often requires hospitalization for discontinuation as a precaution against dangerous and sometimes fatal seizures as part of the detoxification process.^{citation needed]} No other medications in this class have shown this fatal side effect, although abrupt discontinuation of virtually any benzodiazepine can result in cravings, stomach pains, cramps, increased anxiety, insomnia and other signs of withdrawal.

Cognitive-behavioral therapy

Cognitive-behavioral therapy (CBT) is the most popular and effective form of psychotherapy used to treat anxiety. The goal of the cognitive-behavioral therapist is to decrease avoidance behaviors and help the patient develop coping skills. This may entail:

• Challenging false or self-defeating beliefs.
• Developing a positive self-talk skill.
• Developing negative thought replacement.
• Systematic desensitization, also called exposure (used for agoraphobia and OCD mainly).
• Providing knowledge that will help the patient cope. (For example, someone who suffers from panic may be informed that fast, prolonged, heart palpitations are in themselves harmless).

Unlike prescription medication, the effectiveness of cognitive-behavioral therapy depends on various subjective factors, such as therapist competence. In addition to conventional therapy, there are at-home cognitive-behavioral programs sufferers can use as part of their treatment.

Other coping strategies

Supplements

A variety of over the counter supplements and medications are also used for their alleged anti-anxiety properties, however there is little scientific evidence to back up these claims.

• Kava Kava - a popular herbal treatment; small doses either taken regularly through the day or when early symptoms are noticed by the patient.
• Valerian root - also reputed to have anti-anxiety and sedative properties
• passion fruit
• passion flower
• St. John's wort
• hops
• chamomile
• magnesium
• B-complex

Self help

Self help and relaxation techniques also play an important role in relieving anxiety symptoms. Self help includes:

• Proper diet - This includes reduction in consumption of caffeine, sugar, and generally an improvement of eating habits. Caffeine reduction should be gradual. Some anxiety sufferers report considerable reductions in their anxiety just from taking these measures.
• Exercise - Some exercise is thought to relieve stress, by reducing the amount of cortisol built up from anxiety. Anxiety sufferers should note that rapid heart palpitations during exercise can trigger a panic attack, so it is probably better to gradually develop an exercise routine while on a cognitive-behavioral program.
• Laughing
• Breathing techniques and proper breathing - A Diaphragmatic breathing technique is often recommended (as opposed to chest breathing).
• Proper sleep.
• Meditation
• Relaxation techniques - A state of relaxation can be achieved with the help of relaxation tapes, Yoga or relaxation therapy.
• Stress management.- This may entail changes in lifestyle and time management. There are a number of books specialized in stress management.
• Panic attack coping strategies - Specific strategies for dealing with panic episodes have been proposed, such as slow abdominal breathing and use of reassuring self-talk.
• Search for meaning and purpose - Some experts have indicated that residual generalized anxiety can be the result of a sort of "boredom" about existence. They recommend looking for an occupation the sufferer finds meaningful.
• For people who feel anxious and don't know why, it is worthwhile to sort out whether the anxiety is over a particular circumstance or a more abstract existential worry.

Alcohol

Alcoholic drinks are probably the most widely used substance for the alleviation of anxiety. Anxiety sufferers are cautioned that alcohol is also a powerful depressant and has a plethora of dangerous and uncomfortable side effects in addition to being potentially addictive. Some evidence suggests that consuming alcohol to alleviate anxiety may be counter-productive, as it can lead to a higher or irregular heartbeat and lowering of blood sugar which can both add to the unpleasant symptoms of anxiety and panic.

Alternative medicine

A 2002 CDC survey (see table 3 on page 9) found that complementary and alternative methods were used to treat anxiety/depression by 4.5 percent of U.S. adults who used CAM.

Types of anxiety

Existential anxiety

See more under existential crisis.

Theologians like Paul Tillich and psychologists like Sigmund Freud have characterized anxiety as the reaction to what Tillich called, "The trauma of nonbeing." That is, the human comes to realize that there is a point at which they might cease to be (die), and their encounter with reality becomes characterized by anxiety. Religion, according to both Tillich and Freud, then becomes a carefully crafted coping mechanism in response to this anxiety since they redefine death as the end of only the corporal part of human personal existence, assuming an immortal soul. What then becomes of this soul and through what criteria is the cardinal difference of various religious faiths.

Philosophical ruminations are a part of this condition, and this is part of obsessive-compulsive disorder. They are typically about sex and religion or death.

According to Viktor Frankl, author of Man's Search for Meaning, when faced in extreme mortal dangers the very basic of all human wishes is to find a meaning of life to combat this "trauma of nonbeing" as death is near and to succumb to it (even by suicide) seems like a way out.

Test anxiety

Test anxiety is the uneasiness, apprehension, or nervousness felt by students who have a fear of failing an exam. Students suffering from test anxiety may experience any of the following: the association of grades with personal worth, embarrassment by a teacher, taking a class that is beyond their ability, fear of alienation from parents or friends, time pressures, or feeling a loss of control. Emotional, cognitive, behavioral, and physical components can all be present in test anxiety. Sweating, dizziness, headaches, racing heartbeats, nausea, fidgeting, and drumming on a desk are all common. An optimal level of arousal is necessary to best complete a task such as an exam; however, when the anxiety or level of arousal exceeds that optimum, it results in a decline in performance. Because test anxiety hinges on fear of negative evaluation, debate exists as to whether test anxiety is itself a unique anxiety disorder or whether it is a specific type of social phobia.

Stranger Anxiety

Main article: Stranger Anxiety

Stranger Anxiety is not a phobia in the classic sense; rather it is a developmentally appropriate fear by young children of those who do not share a 'loved-one', caretaker or parenting role.

Anxiety in palliative care

Some research has strongly suggested that treating anxiety in cancer patients improves their quality of life. The treatment generally consists of counselling, relaxation techniques or pharmacologically with benzodiazepines.

See also

• Angst
• Social Anxiety
• General anxiety disorder
• Worry
• Ringxiety i.e. Ringtone Anxiety

References

1. ^ Woods JH, Winger G (1995). Current benzodiazepine issues. Psychopharmacology 118(2): 107-15.

Sources

• Rosen, J.B. & Schulkin, J. (1998): "From normal fear to pathological anxiety". Psychological Review. 105(2); 325-350.
• Seligman, M.E.P., Walker, E.F. & Rosenhan, D.L. (2001). Abnormal psychology, (4th ed.) New York: W.W. Norton & Company, Inc.
• Zald, D.H., Hagen, M.C. & Pardo, J.V. (2002). "Neural correlates of tasting concentrated quinine and sugar solutions". J. Neurophysiol. 87(2), 1068-75.
• Zald, D.H. & Pardo, J.V. (1997). "Emotion, olfaction, and the human amygdala: amygdala activation during aversive olfactory stimulation." Proc Nat'l Acad Sci USA. 94(8), 4119-24.

External links

• Social Anxiety and Anxiety in general www.socialphobia.org.nz
• Article: Anxiety Disorders Kathryn J. Zerbe, M.D.
• Article: Treating Anxiety and Depression Kathryn J. Zerbe, M.D.
• eMedicine article on anxiety
• PanicSurvivor article on anxiety

• Stress and Anxiety Clinical Research Unit at the University of Ottawa Institute of Mental Health Research http://www.rohcg.on.ca/roh-internet/webpage.cfm?site_id=1&org_id=1&morg_id=0&gsec_id=197&parent_item_id=237&item_id=1331