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Are You Living With Chronic Worry and Fear?

You may have a Generalized Anxiety Disorder (GAD).

It's not unusual to feel anxious, when you perceive there is a real threat to your or a loved one's safety, security and welfare. Fears, like your child's drug use or your smoking habit may actually pose a real threat to you, at some future time. Thus, anxiety that warns you of a real threat is adaptive; it lets you know that you are at risk for danger through the anxiety that it stirs up in you, until you do something to eliminate the threat.

But, there are people whose physical makeup predisposes them to chronic anxiety, unrelated to threat. They worry about everything, no matter how unreal the perceived threat seems to be. They have a Generalized Anxiety Disorder (GAD). This type of anxiety is not adaptive. It doesn't warn you about anything specific, so that you have no way to put an end to how you feel. A generalized anxiety disorder causes significant distress and impairment in your daily life. You continually anticipate bad things happening to you that can range from missing work deadlines to dying in a natural disaster. Others may see you as neurotic, high-strung, and perfectionistic, because of these anxious behaviors.

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You most likely try to ward off bad things from happening to you, by exercising a lot of control over your daily life and by engaging in other maladaptive strategies to manage the anxiety that you feel. People who have GAD are often diagnosed with the more anxious-controlling types of prsonality disorders, like obsessive-compulsive disorder.

But, make no mistake, GAD is a distinct syndrome that stems from dysfunction in the parts of the brain that deal with fear, emotion and memory. Researchers have known that the amygdala, a pair of almond-sized bundles of nerve fibers in the middle of the brain that help process emotion, memory and fear, are involved in anxiety disorders like GAD. But, until this new study that was conducted by researchers at Stanford University’s School of Medicine, researchers had not been able to peer closely at the nerve pathways that go to and from the subsections of this tiny brain area to other parts of the brain. They found scrambled connections between the parts of the brain that processes fear and emotion and the other brain regions (EScience.com). Scrambled connections trigger anxiety, even when there’s no threat. Moreover, they found that by stimulating a distinct brain circuit in the amygdala, it counters rather than triggers anxiety and enhanced animals’ willingness to take risks (Amygdala circuitry mediating reversible and bidirectional control of anxiety). This discovery could lead to new treatments for anxiety disorders that deal specifically with the circuits in the amygdala.

Until then, however, the mental health field has a rrange of treatments for anxiety that are very effective. The quickest way to reduce your anxiety is through medication. Today, the anti-anxiety medications work quickly, but, like most medications, they are not without side-effects. If you are going to seek treatment for your anxiety, you should know what the research says about medication versus psychotherapy for disorders of anxiety and depression.

The research shows that medication and psychotherapy together work better than either treatment alone.

Medication

Medication reduces your symptoms and permits new learning, as it lowers anxiety enough for you to take risks and implement healthier coping strategies. The Selective Serotonin Reuptake Inhibitors (SSRIs) are usually psychiatrists’ first choice for treatment of anxiety, even though they are typically used as anti-depressants. This is because they are non-addictive and thus safer than traditional anti-anxiety medications (benzodiazepines). For optimal functioning, the mood stabilizing nerve chemical, serotonin, maintains a certain level within our nervous system and brain. Too much or too little causes brain dysfunction. In states of depression and anxiety, serotonin levels are often low. The SSRIs permit serotonin to circulate at higher levels in the nervous system and brain, which alleviates anxiety and depression and stabilizes mood. The typical SSRIs used to treat anxiety are Lexapro and Paxil.The Benzodiazepines include the well-known drugs Valium (diazepam), Xanax (alprazolam), Klonopin (clonazepam), and Ativan (lorazepam). They are no longer considered a first-line of treatment because, although they reduce anxiety quickly, they are addictive. Non-psychiatrists often treat anxiety with this class of drugs, but they are not trained to distinguish between the various psychiatric disorders. I would think very carefully, before you begin treatment with this class of medication. It’s the type of medication that requires you to take more of it to alleviate your symptoms.

Thus, developing an addiction is a risk, with the benzodiazepines. Buspar is another anti-anxiety medication that is neither an SSRI or benzodiazepine. However, like the SSRIs, it leaves more of the nerve chemical serotonin circulating in the body to alleviate anxious symptoms. But, unlike the SSRIs, buspar has little to no affect on sexual desire. 

Psychotherapy

Anxiety is physiological. But, it can be lessened or worsened by the ways that you cope with it. Thus, psychotherapy for anxiety disorders is needed, especially the psychotherapies that emphasize symptom management, like cognitive-behavioral therapy, mindfulness, and the stress-management therapies. Importantly, these therapies teach you ways to calm your brain and body, counter the irrational ideas that lead to excessive fear and worry, and learn better coping behaviors. If you’ve lived with anxiety for long, you have most likely reduced your world, to control some of your anxiety. A trained mental health professional can help you to replace unhealthy, restricting behaviors, with behaviors that open you to new experiences and learning. 

 

Self-Care (Diet and Exercise)

Drink and food choice can trigger anxiety symptoms. Eating nutrient-deficient foods, not getting enough carbohydrates, protein or fat in your diet, or not eating enough can fluctuate blood-sugar levels that trigger anxiety. In particular, however, the omega-three fatty acids have been shown to be quite helpful in treating depression. More recently researchers have studied the relationship between the omega-three fatty acids and anxiety symptoms in substance abusers, as anxiety is a major cause of relapse from drug abstinence. They found that when these patients were given a high dose of omega 3 fatty acids (greater than 2 grams per day), there was a statistically significant reduction in anxiety compared to those receiving a placebo supplement. Moreover, the degree of the anxiety reduced was highly correlated to the decrease of the ratio of anti-inflammatory hormones to omega 3 fatty acids in the blood. It seems that the omega three fatty acids lower inflammation that has a positive effect on anxiety. Patients were able to handle stress better and had significant improvements in mood (Anxiety and Omega-Three Fatty Acids). Exercise, when added to a program of cognitive-behavior therapy for the anxiety disorders, gives additional health benefits, and also extends the positive effects of psychotherapy treatment. Some studies have found that exercise  provides almost the same benefit as treatment with a medication. Researchers recommend exercise in the range of 30-40 minutes, three times per week, for anxiety reduction (PsychologyToday.com; Exercise and Mood).

If you have interest, authors Otto and Smit give you exercise strategies for managing your anxiety (Exercise Strategies, Amazon.com). 

Do You Have A Generalized Anxiety Disorder?

The questions that follow meet the diagnostic criteria for a Generalized Anxiety Disorder (Diagnostic and Statistical Manual of Mental Disorders 4th Ed.; Washington DC: American Psychiatric Association, 2000). You may want to answer these questions, if you think you have a generalized anxiety disorder. 

  1. Do you worry and are you fearful much of the time?
  2. Do you feel anxious, wound up, tense and restless, easily fatigued and worn-out, or have concentration and attention problems, or difficulty staying or falling sleeping ? If you answered “yes” to either question 1 or 2, have the symptoms been present most days over the past six months?
  3. Do you anticipate impending doom, even when there’s little basis to your fears?
  4. Do you struggle to regain control, or relax, or cope with your symptoms, but to no avail?Are your symptoms unrelated to another mental disorder?
  5. Do your symptoms cause you significant distress or problems functioning in your relationships, job, and other areas of your life, and these symptoms are not due to a substance or medical issue?
  6. Can you trace your anxiety symptoms back to your childhood?

If you answered yes to most of these questions, it’s best to get a licensed professional who is best educated and trained to make this diagnosis. In general, the higher the degree, the better educated and skilled the professional is to rule out the various addiction and personality disorders that have anxiety as a feature of the main problem, rather than the problem itself. So many times people are put on the wrong medications, because they went to a professional who did not accurately diagnose the problem.This only adds to their anxiety and discomfort.

Remember, no two patients are alike. The reasons why one medication or therapy approach benefits one and doesn't help another can vary greatly. 

I hope the information that I provide here today is helpful to you. The more you know about psychological conditions and options in treatments, the greater power you have over your psychological well being and health. After all, it’s your life; your health. You should work in a collaborative fashion with your medical and mental health providers. Become an informed consumer, today. Warm regards, Dr. Deborah.

Deborah Khoshaba, Psy.D., is a Clinical Psychologist and Director of Training and Development for the Hardiness Institute, Inc., Irvine, California, since 1989.

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