The following information to be used for educational purposes only, and is not intended to serve as treatment or a substitute for mental health services:
What is Anxiety?
Anxiety is a natural response in the mind and body that human beings and most animals have to help protect themselves from danger. It is a feeling of fear or worry that helped our early ancestors survive by keeping them alert and adequately attentive to threats. For example, when our caveman ancestors heard a growling sound in the middle of the night, their anxiety would prompt their bodies to enter a fight or flight mode, resulting in physiological changes in the body, such as: increased breathing rate, increased heart rate, enlarged pupils to let in more light, and blood being diverted from their digestive organs to their muscles, in order to prepare their bodies for an imminent fight or a quick escape. Once the threat is over, the body can switch from a fight or flight state to a rest and digest state, in which the breathing returns to relaxed breaths, the heart rate returns to normal, pupils shrink back to normal, and blood is diverted from the muscles, back the digestive organs. The coordination of switching from one state to another is often beyond our mental control, and is caused by the release of signal molecules that our brain uses to communicate to the body and other parts of the brain, called neurotransmitters.
Now that we no longer need to live in caves and evade predators on a daily basis, this type of drastic physiologic response to stress may be unnecessary or counterproductive. This concept of exaggerated and detrimental response is not uncommon in other areas of medicine. For example, in congestive heart failure the heart pumps harder and faster in an effort to keep up with demand for blood flow, which ends up putting more stress on the heart, and in autoimmune conditions the immune system becomes so sensitive and aggressive, it ends up attacking the normal parts of a patient’s body. Anxiety can be said to be a body’s over-exaggerated response to daily life stressors.
Anxiety can manifest in many different ways, including generalized anxiety, social anxiety, panic attacks, performance anxiety, obsessive compulsive disorder, post traumatic stress disorder, specific phobias, etc.
What is the treatment for anxiety?
Antidepressants are often given, as they treat anxiety and depression, which is convenient because oftentimes anxiety and depression go hand in hand, and many patients state they rarely have one without the other. Serotonin is a neurotransmitter that brain cells use to communicate with one another, and it is theorized that a low amount of serotonin in the brain could contribute to anxiety. Most antidepressants exert their effects by increasing serotonin production. In general, most of these medications need to be taken every day, for at least 8 weeks to feel response.
Anxiolytics are a type of medication that can be taken on an as needed basis, that the patient will not need to take when they do not feel anxious. Many of these medications work by pushing the body towards a rest and digest state. These medications should kick in within 30 minutes of taking them, and can even sometimes be used for preventing anxiety- like taking medications before the patient performs an activity, such as giving a speech or presentation, or going to a social event, which could be triggering for the patient. [1]
Are panic attacks dangerous?
A common concern for patients with panic attacks is that something is medically wrong with them, because the symptoms can be profoundly physical. Patients are often worried they will have a seizure, have a heart attack, or “lose their minds.” They will go to the emergency room and be investigated for a heart attack, and the ER doctors perform a medical work up, but not be able to find anything wrong with the patient. Panic attacks will not cause any seizures, most of the time do not have any cardiac involvement, and most patients improve on treatment. The tricky thing about panic attacks and anxiety in general is that it is a condition that snowballs onto itself, and becomes a self-fulfilling prophecy.
For example, let’s say a patient may be worried about getting embarrassed at a party. They may get so worried that they might start thinking that people are looking at them. This worry might make them start to tremble slightly, and as they notice their shaking hand, this causes them to be more self conscious and increases their anxiety further. Then they will become so terrified at the possibility of having a panic attack, that they actually initiate one. With medication, therapy and practice, patients are often able to feel a panic attack coming and will be able to control themselves and abort the panic attack. An important first step is for the patient to realize, understand and believe, that their anxiety is just anxiety, and is not a medical problem with their heart, or the beginning of a seizure in their brain. They can assure themselves that they have been through panic attacks several times before, and have felt perfectly fine afterwards, and this time will be no different. Once the patient can interrupt the train of thought that inevitably leads to a panic attack, they can gain confidence in being able to prevent them. There are also coping skills and techniques one can employ, such as deep breathing.
Deep Breathing
Out of all the physiologic changes in the body during the fight or flight stage, breathing is the one bodily response that you can control directly. You are unable to control your heart rate, sweating, and blood vessels, but you can force yourself to take slow, deep breaths when your body has a tendency to take rapid and shallow breaths during a fight or flight situation. With proper technique that can be learned from a therapist, a patient on the verge of a panic attack can take controlled, deep breaths that will force all the other body’s responses (such as heart rate, tense muscles and dilated pupils) to calm down and return to baseline. [2]
Exposure Therapy
A therapist can also guide a patient to deal with certain triggers by helping them adjust to them gradually. The reason this is important is because anxiety thrives off behaviors of avoidance. For example, if a patient had a panic attack in a grocery store, and now that patient feels like they will have a panic attack every time they set foot in a grocery store, they may decide to stop going to grocery stores altogether. If they have a period in which they do not have any panic attacks, they may have some unintended positive reinforcement that staying out of grocery stores is beneficial for them. This may not be immediately distressing to the patient, but over the long term, it begins to disrupt the patient’s functionality and causes them to miss out on important parts of their lives. Exposure therapy is intended to introduce a patient to their fears in a gradual way that will train them to stop avoiding their triggers and gain confidence in uncomfortable situations. [3]
For example, if a patient had a panic attack in a grocery store and now has intolerable anxiety about going to a crowded grocery store, the first step may be to stand in the parking lot for 10 minutes. After that, maybe the therapist will instruct them to stay near the entrance and greet people leaving the store. After the patient has mastered that activity, the therapist may instruct the patient to go into the store during off-peak hours for 10 minutes, then for 20 minutes, then when the store is busy, etc. After spending enough time in the grocery store the patient soon realizes that the store is not as terrifying as it used to be, and can start reinforcing their experiences in the proper direction- that these harmless scenarios are nothing to fear, and need not be avoided anymore. Exposure therapy is also a central treatment for Obsessive Compulsive Disorder.
Anxiety is a very common problem and often goes untreated because people are reluctant to address it. Anxiety is a very natural and essential human response to stress that keeps us safe, and is treatable when it gets too severe to be helpful. It is nothing to be embarrassed about, and is often a difficult battle, but the patients who are willing to put in the work and confront their fears are almost always able to defeat their anxiety and take their lives back.
1.Pharmacological treatment of anxiety disorders: Current treatments and future directions. Frank J. Farach, Larry D. Pruitt, Janie J. Jun, Alissa B. Jerud, Lori A. Zoellner, and Peter P. Roy-Byrneb. Journal of Anxiety Disorders
2. The Effect of Diaphragmatic Breathing on Attention, Negative Affect and Stress in Healthy Adults
Xiao Ma, Zi-Qi Yue, Zhu-Qing Gong, Hong Zhang, Nai-Yue Duan, Yu-Tong Shi, Gao-Xia Wei, and You-Fa. Frontiers in Psychology
3. Enhancing exposure therapy for anxiety disorders, obsessive-compulsive disorder and post-traumatic stress disorder. Joseph F McGuire, Adam B Lewin, Eric A Storch. Expert Review Neurotherapeutics
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