Your guide to understanding anxiety

Everyone experiences nerves and anxiety from time to time, whether it’s before an important exam, a tense sporting event, a job interview or — and it seems this is almost everyone’s greatest fear — having to speak in public. You know the symptoms: excessive worry or fear accompanied by shortness of breath, heart palpitations, and chills or hot flushes often with profuse sweating. If these symptoms escalate into a full-blown panic attack, you may feel like you are going to pass out or even pass away!

Most of the time nervousness and its accompanying symptoms are mild and last only a few minutes. They’re usually manageable with a few deep breaths and some reassuring self talk. However, in as much as 10 percent of the population, attacks of anxiety can be disabling and lead one to avoid future similar situations that may trigger an attack. Some people stay home to avoid potentially embarrassing situations, refuse to attend parties or take public transportation and forego any circumstance from which escape may be embarrassing or impossible (this avoidance behavior is called agoraphobia).

Fortunately, anxiety in almost any form can be effectively managed with lifestyle adjustments, psychotherapy and/or medication.

Anxiety, when it becomes more than just the usual nervousness we all feel from time to time, can be defined as a misinterpretation of thoughts, feelings or events that can lead to an uncontrollable vicious cycle: fear generates symptoms that in turn increase the fear which increases the symptoms, and so on.

Severe anxiety shows up in comes in a variety of forms, including:

• Panic attacks, which are acute and severe incidents of anxiety. If you get them often, you may have what is called panic disorder
• Generalized anxiety disorder, in which excessive anxiety and symptoms persist for months or even years
• Social anxiety disorder, in which everyday social interactions can trigger anxiety
• Post-traumatic stress disorder (PTSD), in which recurrent anxiety is triggered by a traumatic event
• Specific phobias, such as a fear of crowds, heights, etc
• Obsessive-compulsive disorder, associated with highly distressing intrusive thoughts and recurrent physical or mental activities driven by the obsessions (e.g. excessive hand-washing due to a fear of germs, or avoiding driving over bridges due to a fear of heights)

We really don’t understand what causes most kinds of anxiety. The one exception is in clear-cut cases when trauma, such as being exposed to violence or an auto accident, triggers PTSD. Most of other anxiety disorders appear in the late teenage or early adult years. Each of the types of anxiety is quite common; e.g. about 10 percent of the adult population has a specific phobia, as many as 3 percent have generalized anxiety disorder, and 1 to 2 percent have obsessive-compulsive disorder.

If you’re bothered by excessive anxiety, see your health care provider. A careful history, often accompanied by a simple questionnaire, will usually reveal the precise diagnosis and direct therapy tailored to your problem. How do you know if your anxiety is excessive and not just the usual anxiety that life in our stressful world can engender? Whatever your symptoms, if you find that your anxiety is interfering with your enjoyment of life, and especially if it is leading you to avoid situations that your family life, work life, school life, etc. require, then it’s a good idea to seek medical help.

Treatment for anxiety may include lifestyle changes, talk therapy and medication.

The type of psychotherapy best proven to help with anxiety is called cognitive behavioral therapy (CBT). In this type of therapy, you learn how to recognize inappropriate thoughts and fears and how to stop them in their tracks before they lead to disabling panic. Most people see benefit with just 10 to 15 sessions, each lasting about an hour.

The medications that are most often recommended to take on a daily basis to prevent anxiety are in two main groups: the selective serotonin reuptake inhibitors (SSRI’s, such as escitalopram or sertraline) or the selective serotonin/norepinephrine reuptake inhibitors (SNRI’s, such as venlafaxine). These medications are often effective in smaller doses than those used to treat depression. The benzodiazepines (e.g. lorazepam or clonazepam) can be extremely effective taken as needed to abort acute anxiety, but should not be taken often or regularly because of a high risk of addiction and their loss of effectiveness over time if taken on a regular basis. For some people, they can be given initially for a few weeks to control symptoms while waiting for the SSRI to kick in, which can take several weeks. A combination of both psychotherapy and medication may be the most effective intervention.

Leading a healthy lifestyle — meaning eating a balanced diet, getting enough sleep and exercise, and limiting use of alcohol — can also lessen the impact of anxiety on your life. Learning how to use deep abdominal breathing to control anxiety, as well as pursuing other methods that encourage a sense of calm and focus, such as yoga or meditation, can have profound benefits that get stronger the more you do them. Getting a good night’s sleep is also helpful. Exercise has been shown to reduce anxiety as well, creating new nerve cells in the brain that quiet other nerve cells responsible for the fear and physical symptoms of anxiety.

In Your Guide to Managing Anxiety, let’s talk about ways to keep your anxiety in check and CBT techniques that can help you managing it.