I. Is This An Anxiety Attack?
Janice still remembers the first day she suffered from what she later learned was an anxiety attack. She had been busy making preparations for her sister's wedding which was to take place the next week and had also been very excited about her own wedding, the date for which had been set in the coming month. Janice had been driving down to pick up her sister's wedding dress when she suddenly felt a shortness of breathe and found that her palms were sweating.
Thinking that she just needed some fresh air, Janice rolled down her car window a little more but she started feeling worse. Her mouth felt dry, her heart was thumping and Janice felt sure she was having a heart attack. Afraid of crashing the car, Janice pulled over to the side and was about to call 911 when she felt the panic subsiding. Janice was relieved and quickly ascribed the episode to the hectic nature of the last few days. She put it out of her mind and went back to her normal routine.
To Janice's horror however, that was not the last of it. She started to have these attacks more frequently and every time, she felt it was just stress: stress of her job, stress of her sister's wedding, stress of her own wedding preparations, etc. But slowly the intensity of her attacks started to grow. On the night before her sister's wedding, Janice was in such bad shape, she insisted she was having a heart attack and was rushed to the emergency room of the local hospital. After undergoing several tests, Janice was told that there was nothing wrong with her, physically.
This now became a regular pattern for Janice. Without any warning of any kind, Janice would suddenly have a panic attack. The more she thought about them, the more intense and more frequent her attacks became. Janice started staying away from the local super market, the malls, even movie theaters and restaurants. She took too many days off from her work and even if she went to work, when she felt an attack coming on, Janice would quickly hide in the bathroom until it subsided.
As days went by Janice started getting worn out by these panic attacks. She even started thinking she may be going crazy. Finally, Janice's fiancé Hal insisted that she meet a therapist to understand what was going on, though she was very unwilling to do so. Hal even threatened her, saying he would postpone the wedding, if Janice did not get help. Being forced thus, Janice finally went and met a therapist.
Finally, Some Answers
Janice had had some unpleasant experiences with therapists before and she was not looking forward to meeting another one. However, Dr. Silverman was not only sympathetic but also reassuring and was not quick to immediately prescribe medication for Janice. She took time in speaking to Janice, understanding what she was like as a child and asking her to describe her experiences with her parents, friends and family. She explained to Janice that her problems were not physical but psychological – that she was suffering from what was called panic disorder or an anxiety disorder. Dr. Silverman also took great pains to assure Janice that with the proper combination of cognitive therapy, behavioral therapy and medications, she will soon start experiencing relief and that the frequency as well as the intensity of attacks will come down.
Janice was one of the lucky few who actually met a therapist in time and who gave her the right advice. There are many in this country and over the world who are in great distress but suffer in silence, being both ignorant of the condition and the fact that it is treatable, and for fear that they may be considered crazy. In fact, patients with anxiety disorders who are treated effectively through cognitive-behavioral therapy and medications find that their attacks are much reduced over time and in some cases, completely disappear.
Is It Stress Or Anxiety Disorder?
Right from childhood to adulthood, we are faced with many stressful situations. As a child, going to a new school or to a camp away from our parents can cause stress. As grown-ups, we may have to look for new jobs, move to a new city or a new home, we may move into or move out of permanent relationships, get engaged or married, experience the birth of a child, deal with illnesses – all these can be great sources of anxiety and stress.
Typically we undergo stress when we have to deal with unexpected events or changes in our lives. At times, we end up feeling overburdened or overwhelmed by the magnitude or the frequency of the events. Most of us have our ways of dealing with stress and with the help of friends and family are able to cope with these distressing factors. However, there are some who find it more difficult to do so than others. Or there are times when events are so drastic - like losing a loved one or losing a job - that one can experience chronic stress. You may start having headaches, not sleep well, become very moody and irritable, experience stomach distress and so on. Chronic stress may occasionally need treatment from professionals but generally once the situation causing stress has been resolved, the person starts feeling better again.
Anxiety is different from stress to some extent, in the sense that it generally involves more components like emotional and cognitive along with the physical symptoms. Further, the physical symptoms are more severe – you may feel very nervous and tense for an extended period of time. You may occasionally experience shortness of breath, some dizziness, heart palpitations and so on. Anxiety also leads to some serious emotional feelings as well – you may fear that the worst is about to happen to yourself, your family or your friends. Unlike stress, anxiety can continue for some time and can keep you from doing the things you enjoy doing. The sources of anxiety are not always known or recognized and may add to the feeling of distress that you are already experiencing.
Nevertheless, it may surprise you to know that stress or anxiety is good in some sense as it is one way in which the brain and the body help you cope with tough times. When you are under stress, you are more focused on the task at hand and motivated to deal with it successfully. Your body digs into extra reserves of energy and you will find that you can work longer and harder during these times. Everyone goes through such tough situations from time to time and experiences increased levels of anxiety and stress. Once the triggering event has been resolved, your anxiety levels and stress levels come down and you are more at peace with yourself.
In fact, stress is one of the most natural ways our mind and body react when they encounter something that is out of the ordinary. When we are afraid or feel threatened, our body reacts suitably. The adrenal glands start pumping adrenalin - causing the heart to beat faster, the muscles to tense up, blood pressure to rise and the pupils to dilate – all indications that the body’s defense mechanism has been activated. Different people react differently in various situations – some are capable of staying extremely calm even in the most stressful situations while some get completely stressed out while deciding the menu for dinner guests. However, what is common to all those who do experience stress is that once the stressful situation has been dealt with, their state of mind and body come back to normal levels.
Unfortunately, there are times when you may become anxious or stressful during even ordinary times. Riding an elevator or going to the supermarket may cause you great anxiety. In fact, this fear soon turns into an irrational dread of even normal, everyday situations. The kind of fear and worry that you experience are completely out of proportion and may even seem illogical considering the situation you are in. For example, it is quite natural for you to feel some nervousness and anxiety before a big business presentation in front of a large crowd. However, if you start experiencing the same or even heightened form of anxiety while attending small parties or get-togethers, you may have to consider if you suffer from an anxiety disorder.
The most characteristic feature of anxiety disorder is the enormous extent to which it starts affecting your daily life and daily activities. People suffering from anxiety disorders typically suffer from the following physical symptoms.
• Great Restlessness – the person is unable to relax even during weekends or holidays, whether alone or with family.
• Fatigue – the person tends to tire very easily even without any significant mental or physical exertion.
• Muscle Tension – one can feel the constant tension in the back and neck muscles.
• Frequent Headaches.
• Inability to Sleep Well – the person finds it difficult to go to sleep or stay asleep for long.
• Moodiness and Irritability
Of course, one should mention here that some of these symptoms would be experienced even by those under normal stress. However, if the symptoms are intense, frequent and continue over a long period of time and more importantly, seem to have appeared for no apparent cause or reason, the person may be suffering from an anxiety disorder.
If you therefore find yourself unable to control your anxiety, so much so that it has started interfering with your daily life, you should go and consult your doctor or even a mental health professional at the earliest.
II. There Is More Than One Kind of Anxiety Disorder?
Recognizing that you face a problem is just the first step in treating an anxiety disorder. However, as you speak to your therapist you will realize that he or she is trying to identify the specific disorder that may be afflicting you so that your condition may be treated effectively. So now you may wonder if there is more than one kind of anxiety disorder and if so, what are the different kinds or types?
Health experts have identified six major types of anxiety disorders:
1. Generalized Anxiety Disorder
2. Obsessive-Compulsive Disorder
3. Panic Disorder
4. Phobia
5. Post-traumatic Stress Disorder
6. Social Anxiety Disorder.
Each one of these has their own distinct symptoms, as we will get to know in the following sections.
1. Generalized Anxiety Disorder
If you are always worried about a few different things without any apparent reason or your fears are so intense that they are proving to be a serious distraction in your life or you have this persistent feeling that something bad is going to happen to you, it is possible that you are suffering from generalized anxiety disorder (GAD). Typically, people with GAD worry constantly, even in perfectly normal situations and without knowing why, so much so that it starts to affect their job, their daily activities and their social life. They also exhibit physical symptoms like excess fatigue, insomnia, stomach upsets and restlessness, quite regularly.
It is human nature to worry. Everyone gets worried about something or other, from time to time. However, if you have a generalized anxiety disorder (GAD), you may find yourself worrying and fearing everything so much that it starts to interfere with your ability to be able to function normally. In fact, you find it almost impossible to relax, constantly and excessively worrying about different things. You may find yourself spending day after day, feeling very tense and anxious the whole day long.
All of us worry about our finances, our health, the well-being and security of our family and friends. When we face difficulties at home or at work, we are anxious to sort them out and move on. However, with generalized anxiety disorder, this worrying becomes excessive and unrelenting.
A casual remark from the boss about the state of the economy may get you worried about your job, a phone call from a close friend which is not returned during the day causes you anxiety about the relationship being in trouble. At times, just starting the day and getting through it becomes an ordeal.
You may even know that there is no obvious reason or cause for you to feel so disturbed and anxious. You may also realize that your anxiety is far more intense than what the situation may indicate. However, all this may only end up making you feel worse. You find it impossible to switch off the negative thoughts and fears and the anxieties keep running through your head, again and again.
This anxiety also takes a physical toll on you. You may feel physically and mentally exhausted all the time. Your body may ache and yet you are unable to sleep or sleep peacefully for long.
It is possible for some people with GAD to go to work or public places or be in social situations – but they will go about feeling extremely anxious and worried almost all the time even though they may be in the most normal of situations. For some, GAD does take on a very chronic form with the symptoms, especially the physical ones, occurring more frequently and with more intensity making it almost impossible for them to carry on with their everyday functioning.
2. Obsessive-Compulsive Disorder
If you have constant negative thoughts or repeat certain behavior, both of which seem beyond your control, you may be suffering from obsessive-compulsive disorder (OCD). You may be troubled almost constantly by obsessions such as a fear that you have forgotten to turn off the gas or that if you do not place a thing in a particular way, someone close to you may get harmed. You may also have some uncontrollable compulsions like washing your hands repeatedly.
It is quite normal to be concerned sometimes, about whether your door or car is locked properly or whether the gas and taps have been turned off. In fact, on more than one occasion, you may feel the need to go back and make sure that everything is fine. However, when you are suffering from an obsessive-compulsive disorder, you will find that such thoughts and behavior become more and more of a norm. The obsessive thoughts as well as compulsive behaviors go to such an extreme that they start affecting your daily activities. Most importantly, no matter how much you assure yourself or how hard you try, you are not able to shake them off.
The most obvious characteristics of the obsessive-compulsive disorder are the unwanted thoughts that keep haunting one and the repeated behaviors that one feels compelled in doing, to the point of making it a ritual – and no matter how hard you try, you are not able to stop or control these thoughts or behaviors. You may be fully aware that there is no rational reason why you should have these fears or feel compelled to carry out certain acts repeatedly and even then; it is difficult for you to resist them or to stop them. In fact, people with an obsessive-compulsive disorder may take things to an extreme, like checking the lock on the door twenty times, washing the hands repeatedly til they are scrubbed red and raw, driving around the same place for hours to make sure that the thud that was heard was not someone you had run over.
There are typically two aspects to an obsessive-compulsive disorder. The Obsessions are completely involuntary and uncontrollable fears or thoughts that keep coming into your mind. You know they do not make any sense and however hard you may try, you keep thinking these thoughts again and again. They start intruding into whatever else you may be thinking about at that moment and can prove to be extremely distracting and disturbing. Compulsions on the other hand are actually behaviors that you feel forced to indulge in for fear of what may happen if you do not do them. In fact you become so used to doing these acts that they become like rituals. If you are afraid of germs or contamination, you may feel like washing your hands over and over again. You may develop very elaborate cleaning rituals. You may even experience a sense of relief at the end of it but it is very short-lived. You are again plagued by anxiety and the thought of having to go through the rituals again causes you even further anxiety. As you can imagine, this can take up a significant amount of your time and starts to seriously affect your normal, daily life.
People suffering with obsessive-compulsive disorders can be further categorized into the following -
• Those who are afraid of germs, dirt, any sort of contamination in general. These persons are prone to cleaning objects or washing their hands repeatedly.
• Some feel the need to repeatedly check on things to make sure everything is fine like checking locks, the gas, anything they feel, if neglected may lead to some harm or danger.
• Others do something in only one particular way or try to do things perfectly, and are afraid that if they do not it that way or if things are not perfect, something terrible will happen to them or to those close to them.
• Some people with OCD tend to be obsessed with symmetry and order. They cannot bear to see any irregularity in arrangements or numbers and may prefer some colors to others.
• Many others keep hoarding things, however old or useless, for fear that if they throw them out, something terrible will happen to them.
It is important to remember that just because you occasionally have some obsessive thoughts or go through a period of compulsive behavior, you do not necessarily have obsessive-compulsive disorder. It is entirely possible that you are going through a particularly stressful period in your life and these thoughts or actions are caused by it. Once the stressful period is over, you will find yourself in a much calmer frame of mind. However, for people with obsessive-compulsive behavior, these thoughts are all pervading and can cause a great deal of distress, waste a lot of time and cause great interference in their social lives, jobs or even daily lives.
3. Panic Disorder
If you experience repeated panic attacks, which come on you most unexpectedly and scare you with their intensity, chances are you suffer from panic disorder. In fact, quite often, you will start fearing being in situations where you may have to face embarrassment or not get any help in the event of experiencing a panic attack. For example, you may stop going to malls or parlors, even avoiding going to work as much as possible for fear that you may suffer a panic attack whilst you are there.
Panic attacks are different from severe stress or anxiety of a situation. A panic attack is almost always sudden – there is an overwhelming sense of fear and sheer panic sets in. You can feel your heart pounding, your throat getting dry and a sense of dizziness. In fact, so intense are the physical symptoms that most patients often believe that they are having a heart attack, when they are actually having a panic attack. What makes it worse is that there is no warning, no apparent cause for a panic attack to happen. In fact, it is not uncommon for some to experience panic attacks when they are relaxing, even when they are asleep.
While people may experience a panic attack once in a while, many do tend to ignore even repeated occurrences. Some are able to identify the causes of their panic attacks like traveling in closed spaces as in an elevator or having to speak in public. If you have experienced a panic attack in such a situation before and are convinced that you cannot get any help or escape from such a situation, chances are you will experience repeated panic attacks in similar situations.
You have to understand that if you are having repeated episodes of such panic attacks, you may be suffering with panic disorder, no matter how happy or healthy, you may ordinarily be.
4. Phobia
If you have a very unrealistic and yet strong fear of some specific situation, activity or object when it actually poses very little or hardly any danger at all, you may be suffering from a phobia. The most common fears are those of heights and small spaces, fear of flying, of snakes and spiders. If you suffer from phobia, you will go to any length to avoid being near the object or in the situation that you are afraid of. However, trying to avoid the object or the situation that you are so fearful about only ends up strengthening the phobia.
We have to bear in mind that almost all of us have some or the other irrational, almost child-like fear of something. You may know many who are scared of needles, others who cannot stand the thought of bugs or mice. Many feel woozy when they are at great heights while others feel very uncomfortable in elevators or small, cramped spaces. For most people, these fears are minor and do not interfere with their thoughts or their daily activities. However, for some the fears are so intense and so overwhelming that they cannot get them out of their mind and take great efforts in avoiding the object of fear. They go through the entire day with great anxiety, so much so that it starts affecting their daily lives. Such fears that are not only irrational but tend to be crippling as well are called phobias.
Though we have mentioned some of the most common fears that develop into intense phobias like fear of heights, needles, small spaces, insects, snakes, even highway driving, it is true that one can develop a phobia of almost anything. It is also true that while some phobias grow out of certain childhood fears, many adults too develop phobias.
If you are suffering from a phobia, you may try very hard to avoid facing what you fear so much. In fact, you may go to extraordinary lengths, even to the extent of making major changes to your lifestyle. For example, it is not uncommon for people who are scared of small spaces, to turn down lucrative promotions because they may have to ride an elevator to work everyday. There are cases where people who are afraid of heights, take a round about route, driving twenty-thirty miles more to avoid one tall bridge that is enroute to work.
To make matters worse, you may even realize that your fears are unreasonable and that there is no real danger in any of the situations you are so scared of being in. However, no matter how hard you try, you may not be able to control your feelings or your fears. Just thinking about your fears starts making you anxious and when you are actually placed in a situation you dread, you are filled with an overwhelming feeling of terror.
The most commonly found fears or phobias are –
• Fear or phobia of animals like snakes, mice, spiders and dogs.
• Fear of certain natural environments like fear of heights, fear of the dark, fear of storms.
• Fear of certain situations like fear of elevators, fear of small spaces, fear of flying, fear of driving.
• Fears of certain medical procedures or situations like blood, injections and so on.
5. Post-traumatic Stress Disorder
When we undergo a traumatic event in our lives, it is very natural that we feel very disturbed and find it hard to come to terms with life after that event. Even going about our daily activities becomes an ordeal and we often spend days or nights, remembering and feeling distressed over the event. However, as days go by, with adequate support from friends and family, our minds start to heal and we achieve a certain degree of closure with respect to the event. Though there may always be feelings of sadness, we find it easier to carry on with our normal lives.
At times, the trauma or event that we went through is so powerful that we are unable to come to terms with it or find a way to seek relief. You may find yourself constantly thinking about it and as a result constantly distressed. You may have very frequent and very intense nightmares or flashbacks. You may act hyper vigilant, jump easily, withdraw into yourself and avoid any situation or conversation that would remind you of the event. If you are having such great difficulty in getting over your trauma and getting back to your normal activities, you may be suffering from what is called post-traumatic stress disorder (PSTD).
Though post-traumatic stress disorder has been associated more with soldiers scarred by their war experiences, anyone who experiences an event that had threatened your safety or your life, can undergo trauma and later suffer from post-traumatic stress disorder. And what is even more unfortunate is that post-traumatic stress disorder can affect not just those who were personally involved in the event. It can affect those who witnessed it; those who had to pick up the pieces after the event like emergency workers as also close friends and family members. Anyone who could have been touched by the event can be affected by post-traumatic stress disorder.
Some of the traumatic events that can lead people into such situations are:
• War
• Sexual or physical abuse
• Natural disasters like earthquakes or tornados
• An accident like a car or plane crash
• Violent assault like during a robbery
• Kidnapping
It is considered that a post-traumatic stress disorder is just a response mechanism of the mind to deal with what was a completely out of the ordinary situation. As we have mentioned above, anyone undergoing the kind of traumas listed above will be feeling frightened and overwhelmed beyond belief. Their trust and their sense of safety have been completely shattered and they think that their lives can never be normal again. They feel disconnected from the real world and go about their routine work feeling numb about everything. While all these reactions are completely understandable, most people do manage to pull themselves through their personal tragedies and bit by bit, start living normal lives.
Those with post-traumatic stress disorder often find it difficult to come out of the psychological shock they felt and continue to go through the same distressing emotions they first felt. They are unable to cope with the trauma, making it difficult for them to move on.
6. Social Anxiety Disorder
Becoming nervous or self-conscious on special occasions is a very natural thing. You may feel anxious before giving a major sales presentation or before a job interview. However, these are cases of occasional nerves and however anxious you may feel, you feel better once the event is over. For some people, the terror of such social situations is so intense that they try very hard to avoid being in situations where they may have to meet or talk to people. And if they are unable to avoid the situation, they find themselves under tremendous stress til they are able to get out of it. This kind of social phobia is given a special name called social anxiety disorder.
Those who suffer from social anxiety disorder are constantly in the fear that people are putting them to great scrutiny or evaluating them. They are afraid that they will not measure up to the expectations of others and may be judged poorly. They are also afraid that something embarrassing will happen to them in public. Of course, you may be fully aware that these fears are overblown and that there never was a basis for them. In fact, you may be the first to realize that fears of being evaluated or judged by the public are completely irrational. And yet, you find yourself anxious at the thought of being in any social situation.
It is true that many people experience some kind of anxiety when they have to be in a social situation or perform in public – these are generalized social anxiety disorders. People with social anxiety disorder have heightened anxiety in specific social situations like public speaking, going to parties, speaking to strangers and so on.
Some of the situations, which a person suffering from a social anxiety disorder may find very stressful, are as follows –
• Speaking or performing in public.
• Making small talk particularly with strangers.
• Talking with people of authority.
• Attending social gatherings or parties.
III. What Causes Anxiety Disorders?
If you or someone close to you has been diagnosed with an anxiety disorder, you may be wondering at what causes these anxiety disorders. The answer is there are many factors that can contribute to or cause an anxiety disorder. Typically, a combination of a few of these factors coming together, over an extended period of time, can cause anxiety disorder in a person. It is unusual thought not rare for one factor alone to cause such anxiety and distress as is associated with anxiety disorders. It is possible that a single traumatic event may result in an anxiety disorder but typically it is believed to arise as a result of the combination of many biological, social and psychological factors.
Studies carried out so far have indicated that some factors play a major role in contributing to anxiety disorders. These are:
• Neurological Factors
• Heredity or Genetic Factors
• An Overworked or Overstressed Lifestyle
• Childhood Experiences
• Personality Factors.
Let us try and understand how each one of these factors can contribute to heightening a sense of anxiety in a person leading to anxiety disorder.
1. Neurological Factors
When we feel we are in danger or feel threatened, our body has an inbuilt defense mechanism that helps us fight or flee. This consists of both physical and psychological reactions that aid us in acting to protect ourselves.
The physical reactions include an increased heartbeat, fast breathing, muscle tension and so on. The adrenal gland pumps out more adrenalin and you may actually feel more energy inside of you. These are the ways in which the body hopes to help you resolve the situation that is causing you anxiety. In fact, in most cases, it does. When you are stressed or afraid of any situation, all the above reactions help you to focus more on the problem at hand and work on resolving it.
For some people, however, these reactions tend to be of an extreme nature. Not only that, the mind starts perceiving everyday happenings and normal situations as life threatening. The body therefore is always in a heightened state of anxiety and continues to be in an equivalent physical state. The body continues to trigger responses similar to those when faced by danger even though no real danger exists.
There are indications that this kind of overreaction is caused by a certain kind of chemical imbalance in the brain. Though it is still not clear what causes this imbalance, the fact that medications aided to restore the chemical balance have helped reduce the anxiety disorder, seems to suggest that it does play a role. There is ongoing research to determine whether the overreaction to situations causes the chemical imbalance or the imbalance brings about the extreme reactions.
Many have found that as soon as their body starts exhibiting these physical symptoms, if they practice some relaxation techniques like deep breathing or meditation, it provides them with some relief and calms their system.
2. Heredity or Genetic Factors
If there is one factor that research is fairly clear about, it is that anxiety disorders tend to be hereditary. In other words, they tend to run in families. If one member of the family is exhibiting anxiety disorder, chances are more members of the family are likely to have a predisposition to this disorder. In fact, research has shown that amongst identical twins, if one twin has an anxiety disorder, the other identical twin is more than likely to have it too. This is not always true in case of non-identical or fraternal twins, indicating that genetic factors too play an important role in the development of anxiety disorders. When these genetic or hereditary factors combine with other stressful life experiences, anxiety disorder may be triggered.
3. An Overworked or Overstressed Lifestyle
When you are under stress or feeling overworked, your body and mind trigger responses that will help you get through the stressful period. They believe your safety is being threatened and emotional as well as physical responses are triggered to help you overcome those conditions. Once the stressful period is passed, your body and mind need time to heal and get back to experiencing normal activities again.
However, if you are constantly under stress and have poor lifestyle habits such as overworking, lack of rest and recreation, lack of adequate sleep, poor diet and lack of exercise, your body and mind are constantly at heightened anxiety levels. If they are not given time to relax and recover, your body and mind will be constantly under stress and will start reacting even to daily events as though they were real dangers.
Let us consider the typical day in the life of a busy working person – say, a marketing executive like Doug, and how an overload of stress can contribute to an anxiety disorder. After working for about 65-70 hours every week, Doug hardly has any time to sleep, let alone take some time out for himself. He has been going from one relationship to another and hardly spends any time at home. Doug has no time to exercise and to save time, he mainly survives on fast food. Over time, Doug’s body started viewing these continuing stressful factors as a constant threat to his survival. It started staying in a state of constant alert and even ordinary situations seemed life threatening to Doug. His physical and mental anxiety kept increasing til he started having repeated anxiety attacks.
While it is not possible to completely eliminate stress from your life, it is certainly in your power to get rid of as many stressors as you possibly can. Some of these are simple to do like having a healthy diet, exercising regularly and getting enough sleep. Others may need some work – like working through stressful periods more calmly and taking time out to cool down. This way your body and mind will learn to wind down once the stressful period is over.
4. Childhood Experiences
Many underestimate the impact our childhood experiences have on us. Many unfortunately come from abusive homes where their childhood experiences would have left a scar on their young minds. Even as adults, the anxiety and fear that they would have felt as a child would have stayed with them. Combined with any other stressful event or period of extended anxiety, these feelings can quickly result in an anxiety disorder.
Even when adults around you have meant well, their actions and thinking would have left a very deep mark on you. For example, you may have picked up some beliefs or habits that contribute to anxiety. You may have somehow been given the impression that only by being successful can you gain love and acceptance. You may have been constantly criticized or judged and not been allowed to express your opinions or your feelings freely. You may have watched adults in your family or close to you react to things in life with great anxiety.
5. Personality Factors
The psychological make up of a person has a lot to do with how one copes with stress and anxiety. It has often been found that a person with low self-esteem and inadequate coping skills is more prone to an anxiety disorder. Such a person may have a lot of negative thought patterns and may find it difficult to come out of these moods.
While everyone has negative thoughts occasionally, some are unable to keep these from overwhelming them completely and are also unable to find ways in which they can replace them with positive ones. If these people do not find ways of enhancing their self-esteem or find ways of coping with disappointments in life, they may find themselves having to deal with an anxiety disorder.
IV. How Can I Get Help?
If you have been diagnosed with an anxiety disorder - been told that there is nothing wrong with you physically and that this is just a psychological disorder, chances are you may feel more distressed about it. You are not sure how your family and friends are going to react and more importantly if there is a way of treating this disorder effectively.
Anxiety disorders are highly treatable and many patients find their symptoms much reduced, and in some cases completely gone after they have been treated. Not only are present treatment methods fairly effective but also, new therapies are being developed and discovered every day.
Each anxiety disorder has its own unique symptoms but in general, almost all anxiety disorders respond very well to a treatment combining medication and psychotherapy. In some cases medication alone may be prescribed while in some, psychotherapy may do the job. However, they seem to have maximum impact when combined together and relieve most symptoms of anxiety disorders.
Before we start looking at various ways of treating anxiety disorders, we may want to quickly look at how a diagnosis of anxiety disorder is arrived at.
Diagnosis of Anxiety Disorder
When a person known to you seems to be exhibiting many symptoms of an anxiety disorder, before proceeding with treatment, it is best that a careful evaluation and then diagnosis be carried out. It is best to take the person to a qualified and experienced psychiatrist who will conduct thorough diagnostic evaluation tests as also review all the previous medical records. The psychiatrist will interview the person in detail to get a first hand knowledge of what the person is feeling. During the course of the evaluation, the physician tries to make sure that there are no other medical conditions that may be leading to similar symptoms such as those of an anxiety disorder. After all the tests and interviews, the physician makes a proper diagnosis and will start prescribing a course of treatment which may include either medications, therapy, or a combination of both.
Treating Anxiety Disorders with Medication
The most typical medications that are given to treat anxiety disorders are antidepressants or mild tranquilizers, and similar anti-anxiety drugs. Of course, in each drug class, there are many choices of medication and if one drug does not provide adequate relief, a physician may try prescribing another drug. However, anti-anxiety drugs take a few weeks to start showing results and so patients have to show patience and keep taking their medications regularly. They also need to be monitored regularly by their physician so that it can be determined it the patient needs any change in dosage, a change in drugs or perhaps some additional drugs.
Before you start taking medications for your anxiety disorder, you should take the following precautionary measures.
• Speak frankly with your doctor and try to understand the effects as well as the side effects of the medication you are being asked to take.
• You should mention to your doctor about any medication you are already taking even though they may be just over the counter medications or to do with any alternative therapies.
• Do not stop taking the medications abruptly since that may have serious side effects, not to mention bring about a relapse in your condition. Speak to your doctor before hand about how you can go about slowly getting off medication once you start feeling better and in control of yourself.
• Help your doctor understand what medication and what dosage is working best for you.
Treating Anxiety Disorders through Cognitive Behavioral Therapy
Of all methods of psychotherapy, Cognitive-Behavioral Therapy has been one of the most successful ones in treating anxiety disorders. This works in two ways – the cognitive aspect helps you to work on your thinking patterns, helping you to overcome the feelings of fear and anxiety; the behavioral aspect helps you to work on your actions and behaviors, helping you to respond positively even in fairly stressful situations.
Cognitive-Behavioral Therapy, for example, helps people who suffer from panic disorders understand that what they undergo are not heart attacks and equips them to deal with these attacks more calmly. Similarly, those with social anxiety disorder are taught to slowly overcome their deep-rooted belief that people are always scrutinizing them and evaluating them.
Once people are shown what they are afraid of, the next step in cognitive-behavioral therapy is to get them to confront those fears. They are shown techniques by which they can expose themselves to situations or objects they are most afraid of so that they gradually get desensitized to those situations.
Some people suffering with obsessive-compulsive disorder are afraid of contamination. They are encouraged to slowly get their hands dirty and then wait for a certain amount of time before they wash them. This waiting time is gradually increased and while waiting, the therapist speaks to the patient and tries to deal with the anxiety that the person is going through. Gradually, as this exercise is repeated a sufficient number of times and the waiting period also becomes fairly long, the patient finds that the anxiety felt is much diminished and the person feels more in control.
Similarly, those suffering with social anxiety disorder may be told to knowingly spend time in small parties or social gatherings. They may even be told to commit small social blunders just so the patient can see how others react and to convince him or her that the response is never very harsh or unpleasant as is feared. Again, the person’s anxiety is diminished.
Those who suffer from post-traumatic stress disorder may be asked to talk about what they went through or suffered, in the presence of friends or family they are comfortable with and in a place, the person finds safe. Gradually they will learn that there is nothing more to fear from events that have happened in the past.
Surprising though it may sound, even persons suffering from specific phobias respond well to exposure-based behavioral therapy. The person suffering from the phobia is made to slowly face the object (like a snake or spider) or situation (like driving or being in an elevator). The first few times, he or she may only be shown a picture or a tape and as one gets used to this, he or she is then brought face to face with the object or situation. Almost always, the therapist will be present with the patient to help provide support, guidance and words of advise as he or she prepares to face his or her fears.
It is important to remember that cognitive-behavioral therapy is to be undertaken only when the patient feels mentally ready. Only when they willingly give permission and are ready to fully participate in the therapy can the treatment be effective. Further, the therapy has to be tailored to meet the particular anxieties of the person and take into account whatever other needs of the person may be.
Typically, cognitive-behavioral therapy session last for about 12 weeks and while they may be conducted individually, more often than not they are conducted with a group of people. Group therapy provides more moral support to the patients just by allowing them to know that there are many more who suffer the same way they do. Also, patients with social anxiety disorders do much better in group therapy sessions. Patients are assigned ‘homework’ so that they can work on their anxieties and deal with them during day-to-day activities. Of course, not everyone is cured permanently and there are cases where the disorder returns. However, cognitive-behavioral therapy is proven to have longer lasting effects than medications and even when the disorder returns, it is more effective in treating it.
Of course, the most distinct advantage cognitive-behavioral therapy has over medication is that there are absolutely no side effects other than brief period of heightened anxiety when the patient is made to face his or her fears.
Cognitive-Behavioral therapy is now considered a fairly effective method of treatment and combined with medication can provide one of the best approaches to treating anxiety disorders.
Treating Anxiety Disorders through Complementary Treatments
While medications and cognitive-behavioral therapy have proven to be very effective methods of treating anxiety disorders, new treatments and therapy methods are being developed all the time. There are many methods that are showing great promise in treating anxiety disorders in complement with the other methods. In fact some of them have shown to be very effective, even by themselves, in treating mild cases of anxiety disorders. Some of these methods are as follows.
• Regular Exercise – Though almost everyone is aware of how important exercising is for one’s physical health, not everyone is aware that it is equally important for one’s mental health. In fact, research has shown that moderate exercise every alternate day can significantly reduce one’s feelings of anxiety.
• Using relaxation techniques – When one is feeling overwhelmed with feelings of fear and anxiety, it helps to know some relaxation techniques like meditation, controlled breathing and gradual muscle relaxation, positive visualization. All of these are aimed at reducing the feelings of anxiety, increase feelings of calmness and emotional well-being and help achieve a sense of control.
• Using Biofeedback - Biofeedback mechanisms use technology to learn what the body is telling the brain. They use sensors attached to various parts of the body to send feedback about heart rate, breathing and the tension in the muscles as soon as one starts to experience an anxiety attack or even before. This feedback is used to educate you on how to recognize when an attack may be coming on and then to use relaxation techniques to effectively ward it off before it completely overwhelms you.
• Hypnosis – Though there are many debates over the effectiveness of hypnosis as a method of treatment, it has been found useful by many patients in treatment of their anxiety disorder. During hypnosis, the patient is in a state of deep relaxation and the therapist then uses many techniques to get the patient to face his or her fears and slowly introduces to them ways of dealing with these fears.
V. Learning to Conquer Fear
If you are suffering from an anxiety disorder, chances are you will find tremendous relief from one or a combination of the treatment methods mentioned above. However, not all anxiety and panic attacks stem from anxiety disorders. They are only an indicator that you are under more stress than what your body or mind can handle. Therefore, the best thing you can do to help yourself, is to learn to conquer your fears and your anxieties through the steps we have outlined below. Chances are that if addressed at the right time, some of your fears may be resolved and you will experience some relief, without slipping into an anxiety disorder.
Everyone gets worried about some issues at some stages of their life. As children, we may worry about school and teachers; as teenagers, we worry about college and peer pressure and as adults, we worry about jobs and relationships. Worrying is helpful when it helps you to focus, take actions and resolve the problem.
More often than not, for some people, worrying becomes a constant occupation. They start to obsess over worst-case scenarios when there are no obvious reasons to be so concerned. If you are being plagued by unrelenting fears and doubts then this kind of worrying is certainly not helpful or motivating but instead paralyzing and highly disruptive. They only sap your emotional energy, heighten your anxiety levels and start interfering with your daily activities.
Chronic worrying of this kind in combination with other factors, like a genetic predisposition to anxiety disorders or the occurrence of a traumatic event, can result in an anxiety disorder. However, taking steps to break this mental habit of being constantly anxious can go a long way in avoiding a complete breakdown and the onset of an anxiety disorder.
We all know that constant worrying is not good for our physical or mental health. It does not let us sleep at night, makes us feel edgy and irritated during the day, and by the end of the day, you are almost a nervous wreck. You may have tried very hard to just stop worrying but find that the thoughts are completely out of your control, so much so that now you are now worried about your worrying.
However, it should be noted that for most worriers, the anxieties they feel arise from the positive or negative ideas they may hold about worrying. You may believe that worrying constantly about your health or the health of your family is going to actually affect them. On the other hand, you may believe that by worrying so much, you may prevent some bad things from happening or that you are prepared for the worst. This kind of thinking is worse, because you start to cultivate the belief that by worrying you are in some way protecting yourself. You start believing in it so much that your mind works constantly to raise fears and anxieties so that you feel you are protected.
The most important thing to do therefore is to understand that worrying certainly does not protect you and you are better off taking steps to tackle these fears right away. We give below some self-help tips to tackle anxiety and panic attacks.
1. Stopping Anxiety and Panic Attacks, Tip 1: Remember that worrying does not protect you.
While everyone likes to have a well-planned day in general, many cannot stand any kind of uncertainty. They have to know and plan everything with great uncertainty. So much so that any small doubt or concern leaves them very nervous. They cannot handle any unpredictability and when they are not completely sure of something, they start to worry. They believe that by this kind of chronic worrying wherein all the worst possible scenarios are played out in your mind, they are protecting themselves against whatever has to happen. Of course, just because you are worrying about the future does not mean that life does not have its doubts or confusion. They will always arise not matter how hard you try. Therefore, by just thinking of worst-case scenarios when you have not the slightest reason to do so does not prevent the situation from occurring. To the contrary, you have wasted precious happy moments of the present time. Try to stay as much as possible in the present instead of thinking too much about the future. Also, come to terms with the fact that there will always be some uncertainties in life, no matter how hard you try to resolve them.
2. Stopping Anxiety and Panic Attacks, Tip 2: Worry only during specific periods.
If you find yourself being overwhelmed with worrying thoughts so much so that you are not able to achieve anything or do anything productive during the day, then you may need to find a way of just keeping these thoughts at bay. Try to give yourself some worry period during which you can return to your worrying thoughts, keeping them away for the time being. Of course, you are not going to be able to lock those thoughts away all the time whenever you want for whatever period you like. They may still come back to haunt you but if you do this repeatedly, you will train yourself not to think about these worries during the day when you have to concentrate on work and family. You will train your mind to keep the anxieties aside for as long as possible til you are able to think about them in your worrying period.
3. Stopping Anxiety and Panic Attacks, Tip 3: Do not let reality get distorted.
If you are constantly worried and anxious, it is entirely possible that you look at situations differently from what you would have done had you been in a calmer state of mind. The moment you are faced with a challenge or a problem, you may overestimate the chances of things going wrong and start with the assumption that you are not going to be handle the situation or that you will handle it badly. You will have little or no faith in your ability to resolve the problem and are firmly convinced that you are going to simply fall apart. These negative thoughts often prove to be self-fulfilling prophecies. These are not merely pessimistic thoughts but what are considered as distortions of reality. In fact, even though you may know that your thoughts are not based on reality, you will find it difficult controlling them and further more to remove them from your mind. Very often, you have been so used to this pattern of thinking when faced with a tough situation, that you may not even be aware of the problem or the extent of the problem. Therefore, in order to be able to stop this habit of having negative, pessimistic thoughts, you need to change the way your brain thinks. For that you need to be identifying the negative thoughts, the frightening thoughts that appear in your mind. Once you identify what exactly is worrying you or scaring you, do not treat it as a reality but just as a distant possibility. Slowly try to develop scenarios in which you are able to tackle these fears and be successful. As you keep analyzing and working on your fears and anxieties, you will find that you have a more balanced perspective towards any challenge that you might face.
4. Stopping Anxiety and Panic Attacks, Tip 4: Train your mind and body to relax.
When you are anxious or worried, you not only have emotional responses but intense physical responses as well. Your body goes into what is called a ‘fight or flight’ reaction to a situation it perceives is threatening to your safety. Typical responses are as follows – your heart beats faster, your breathing becomes irregular, your muscles are all tensed up and you may even feel a little light-headed. All these responses are intended to help your mind and body stay focused on the problem at hand and resolve it effectively. Once the problem has been sorted out, your body should typically return to its normal, relaxed state of mind, in which the heart is beating much slower, you breathe more deeply and slowly, your blood pressure is back to normal and your muscles relax.
If you are in a constant state of anxiety, your body too will constantly be exhibiting the typical symptoms of stress. If you develop techniques to help your body and mind relax, chances are you will also start feeling less anxious in your mind. There are many relaxation techniques which people with anxiety disorders in particular have found to be very helpful including deep breathing, meditation and working on muscle relaxation. However, it is very important that one practices these techniques regularly and not try them only when they feel very stressed out. One should try to practice some kind of relaxation method for at least thirty minutes everyday. This will help the body develop its relaxation response so that gradually, whenever you feel anxiety and start to feel tense, it naturally learns to relax.
We will briefly mention here some of the relaxation techniques that may be very helpful to you whenever you experience anxiety.
• Muscle Relaxation: Whenever you get tense, invariably you will find the muscles in the back of your neck and shoulders feel tense and tight. Learning to relax these muscles will tell your whole body to relax. Practice this technique even when you are not particularly anxious – systematically tense and then relax various muscle groups of the body. You will notice that as your muscles and your body relax, so does your mind.
• Deep Breathing: When you are worried and anxious, you will notice that your breathing gets faster. At times, it may get so bad that you may feel breathless, get tingly hands and feet and experience dizziness. These symptoms cause more panic in you til you are convinced there is some physical problem with you. By learning to breathe deeply at such times, you can not only reduce these symptoms but also reverse them, helping you to relax and calm down.
• Meditation: Regular meditation is supposed to help many people not just reduce their levels of anxiety but also avoid it to a large extent. In fact, studies have shown that meditation enhances the activities on the left side of the brain, which is believed to be responsible for our feelings of peacefulness and joy.
5. Stopping Anxiety and Panic Attacks, Tip 5: Make time for yourself.
Our busy lifestyles often make it difficult for us to make time for ourselves. When we are stressed or anxious, we may feel that working harder and for longer hours is the solution. However, it may surprise you to know that leading a more balanced lifestyle often plays a very big role in keeping away anxieties and negative thoughts.
There are a number of ways in which you can develop a healthier, balanced lifestyle for yourself.
• Get help and support when you need it: Your anxieties and fear always seem worse when you are alone and there is no one to talk about. Though you may feel hesitant to talk about your problems, you may find that speaking to someone sympathetic greatly relieves you of your worries. Talk to a friend, family member or join a support group. Just being able to talk about your fears may make them seem less scary.
• Learn to eat right: It is very important that you eat the right kind of food at the right times. It is best to start your day with a good breakfast and continue with smaller though frequent meals. If you go for long periods without eating, your blood sugar levels drop making you even more anxious and irritable. Make sure you take a balanced meal every time you eat with plenty of fresh fruits, vegetables and complex carbohydrates. These complex carbohydrates help in stabilizing the levels of blood sugar and increase the levels of serotonin, the neurotransmitter that is believed to have calming effects.
• Limit your intake of sugar and caffeine: Both caffeine and sugar can increase your anxiety levels, cause sleeplessness and even trigger panic attacks. Limit the amount of coffee, tea or soda that you drink as also the amount of desserts or sugary snacks that you eat.
• Avoid smoking and alcohol: While alcohol and smoking may give the impression of having the ability to reduce your anxiety or worry, this relief is only temporary. Further, as the initial effects wear off, you may find that your anxieties have only deepened. Also, if you smoke or drink to reduce your anxiety, it may just lead you down the path of addiction.
• Exercise regularly: One of the most effective and yet often overlooked ways of treating anxiety is to exercise regularly. It is recommended that for maximum relief, one should try and do some kind of aerobic activity, at least every alternate day. Aerobic exercise not only helps increase our physical and mental energy levels, it helps to naturally increase the levels of endorphins, chemicals that stimulate a feeling of well-being in the brain.
• Sleep well: It is natural for you to have some sleepless nights when you are under stress but lack of sleep in turn can cause more anxiety. Give yourself enough time to relax and sleep well enough so that your body feels rested. You are then in a better shape to handle your anxiety and stress.
In conclusion, you can get help to stop anxiety and panic attacks. So reach out and get the help you need and live a less stressful, anxious life.