Anxiety

Co-Written by Carol Polito

Definition of Anxiety

Anxiety is an unpleasant emotional state that involves a complex combination of emotions that include fear, apprehension, and worry. It is often accompanied by physical sensations such as heart palpitations, nausea, chest pain, shortness of breath, or tension headache.

Components of Anxiety Disorders

Agoraphobia

Anxiety about being in a situation that it would be difficult to escape, or difficult to be helped.

Panic Attack

Intense dread, discomfort, and somatic symptoms develop and peak quickly.

Description of Anxiety Disorders

Panic Disorder

Repeated panic attacks and constant worries about having another panic attack

Agoraphobia without History of Panic Disorder

Specific Phobia

Fear of a specific object or situation

Social Phobia

Afraid of and embarrassed in social situations (especially if being evaluated)

Obsessive-Compulsive Disorder

Recurrent and persistent thoughts and/or behaviors that are useless and disrupting

Post-traumatic Stress Disorder

Re-live a very traumatic event

Acute Stress Disorder

Similar to PTSD, but occurs right after the event and lasts no longer than a month

Generalized Anxiety Disorder

Uncontrollable and excessive anxiety and worry about everyday life “stuff”

Anxiety Disorders Due to a General Medical Condition Substance-Induced Anxiety Disorder

Anxiety Disorder Not Otherwise Specified

Prominent anxiety symptoms do not fit into any other category

Signs and Symptoms

The anxiety can be very generalized (everyday stuff)

• Well-being of family members
• Job performance
• Finances
• Relationships
• Household maintenance
• Being on time

The anxiety can be specific

• Overestimating the threat of events or situations
• Excessively worrying about what could go wrong
• Unable to take action or control

Somatic Symptoms of Anxiety

• Muscular aches, pains, or soreness
• Fatigue
• Twitching or trembling
• Headaches
• Stomach problems (irritable bowel syndrome, nausea, diarrhea)
• Grinding of teeth
• Dry mouth
• Sweating, hot flashes
• Dizziness, lightheadedness
• heart palpitations

Psychological symptoms of anxiety

• Chronic worry about events that are unlikely to occur
• Difficulty in stopping anxious thoughts
• Feelings of dread
• Restlessness and inability to relax
• Difficulty falling or staying asleep

Behaviors of anxiety

• Inability to concentrate
• Easily startled
• Procrastination
• Irritability
• Problem solving difficulties
• Indecisiveness
• Impatience
• Easily distracted

Causes of Anxiety

There are, officially, no known causes of anxiety. It is perceived to be an interaction of biological, environmental, experiential, psychological, and cultural factors associated with:

• Imbalance of certain neurotransmitters in the brain
• Poor diet
• Lack of exercise 
• Insufficient sleep
• Hormonal imbalances (puberty and menopause)
• Low blood sugar

Risk Factors of Anxiety

Childhood Adversity

Early traumatic events may increase vulnerability to anxiety

Illness

Worrying about the future, health, family members, finances, responsibilities

Personality

Certain personality types are more prone to anxiety

Genetics

Runs in families

Treatment and Management of Anxiety 

Anxiety Common Treatment

Combination of Psychotherapy (Cognitive Behavior Therapy) and medication

Anxiety Medication

First-line agents

• SSRI’s: 
  • Lexapro – Escitalopram 
  • Paxil – Paroxetine
  • Zoloft – Sertraline
  • Prozac – Fluoxetine 
• SNRI’s: 
  • Effexor – Venlafaxine XR

Second-line agents

• Benzodiazepines
  • Rapid but addictive
  • Xanax, Valium, …
• Buspar – Buspirone
  • Safe, but not as effective
• Tricyclic antidepressants
  • Tolerability issues
  • Imipramine

Cognitive Behavior Therapy

Cognitive Behavior therapists feel that worry is an effort to avoid intense emotional experiences. Therapists aim to change negative thoughts so that negative mental processes are prevented. They teach about anxiety, the difference between healthy and unhealthy worry, and learn topics and triggers of worry in their patients.  Cognitive Behavior Therapy aims to change faulty and unrealistic thinking or belief patterns and instil time management and problem solving skills

CBT Relaxation Techniques

Guided imagery (worry exposure) – Suggestions and thoughts direct imagination to a relaxed and focused state, the body responds as though imaginations are real.

Progressive muscle relaxation – Contract certain muscle group, then relax. Learn the signs of tensed muscles to recognize and release tension. When the body is calmed, so is the mind

Deep breathing exercises – On inhalation, the abdomen should extend outward, and on exhalation, it should come back in. If your shoulders rise and fall, then your lungs are not taking in their full capacity. The Parasympathetic System conserves energy as it slows the heart rate, increases intestinal and gland activity, and relaxes sphincter muscles in the gastrointestinal tract.

Biofeedback – Mentally regulating physiological functions (heart rate, blood pressure, body temperature, digestion). Studies show that a combination of medication and biofeedback is more effective than either therapy alone

Cleanse your Diet

Avoid caffeine and refined sugars, excessive use is linked to arousal and irritability. Avoid processed foods and alcohol. When we are anxious, our bodies need certain nutrients:

• Antioxidants
  • Vitamin C
    • broccoli
    • brussel sprouts
    • papaya
    • cabbage
    • green vegetables
    • sweet potatoes
    • berries
    • carrots
    • beets
    • peas
  • Vitamin E
    • wheat germ
    • avocado
    • whole grain and unrefined breads 
• Magnesium – a relaxant 
  • Green vegetables
  • black beans
  • peas
  • nuts
  • seeds
  • whole and unrefined grains
  • okra
  • pumpkin seeds
• B Vitamins (especially B6) – Aids in serotonin production
  • Green vegetables
  • whole and unrefined grains
  • nuts
  • eggs
  • fish
• Calcium
  • Salmon
  • rhubarb
  • sardines
  • tofu
  • green vegetables
  • okra
  • peas
  • beans
  • brussel sprouts
  • almonds
• Iron
  • Beef
  • turkey
  • chicken
  • veal
  • fish
• Zinc
  • Beef
  • lamb
  • brown rice
  • lentils
  • oatmeal
  • crabmeat
  • salmon
  • beans
  • turkey
  • spinach
  • peas
  • lobster
  • rye bread
• Selenium
  • Fish
  • shrimp
  • crimini mushrooms
  • barley
  • lamb loin
  • asparagus
  • garlic

GABA (Gamma-Aminobutyric Acid)

Taking gaba as a supplement prevents the overstimulation of neurons, balances neurotransmitters and improves circulation to the brain and calms brain function. Eating oatmeal, whole unrefined grains, and granola help to naturally balance the GABA in your body’s systems.

Exercise

Exercise Increases mood-enhancing neurotransmitters and endorphins, releases muscle tension, and decreases stress hormones. Most importantly, exercising is free and very important, so schedule it into your day!

Sleep

Make sure the environment is appropriate (peaceful room, comfortable bed, hide the clock, the bed is for sleeping only). Have a planned sleep schedule. Keep a pad and pencil on your bedside table for jotting down sleepy thoughts. Follow a good diet, avoiding large amounts of food or water right before bedtime. Upon waking, expose yourself to bright light and do some exercise to get a fresh start!

Alternative Therapies

Therapeutic Writing

Choose a topic that you have been bothered by. Get all worries onto paper by writing for 15 minutes.
Tear it up afterwards

Aromatherapy

Surround yourself with uplifting and soothing scents of:

• Lavender
• Roman Chamomile
• Bergamot
• Patchouli

Use a diffuser and essential oils

Massage Therapy

Decreases arousal and stress hormone levels while reducing muscle tension

Parasympathetic Nervous System – sometimes can be personified by panic attack, headaches, fatigue, GI problems, and heart disease.

Concepts to keep in mind

Accept the anxiety instead of avoiding the “unthinkable”

• Magnified fear
• Usually unrealistic
• Consider possibilities and likelihood

Surrender control and perfection by being okay with whatever happens

Learn to say NO

• Say NO when saying yes makes you feel stressed, resentful, or angry
• Say YES when you feel physically, mentally, emotionally, and spiritually energized by whatever is asked of you

Don’t forget to sleep, exercise, and eat well!!!!!

References

Andrews, L. W. (2005). Stress control: for peace of mind. New York: PRC Publishing.

American Psychiatric Association. (2000). Diagnostic and statistical manual of mental disorders (4th ed., text rev.). Washington, DC: Author.

Generalized Anxiety Disorder. (2006, July). Canadian Journal of Psychiatry, 51, 51-55.

Jaffe-Gill, E. (2006, August 14). Generalized anxiety disorder (GAD): symptoms, causes, and treatment. Retrieved October 6, 2007, from http://www.helpguide.org/mental/generalized_anxiety_disorder.htm

Somer, E. & Williams, J.  (2004). The food and mood cookbook. New York: Henry Holt and Company.