About 40 million adults have an anxiety disorder in the USA alone. There are millions more in the rest of the world, with an enormous cost in healthcare, disability, and suffering. Only about a third of the sufferers seek treatment. It is time to change that.
“Regular anxiety” or anxiety disorder?
In a previous post, we addressed that: http://goo.gl/ToC2h4. All of us feel anxious from time to time, but the link above outlines 7 signs that you might be transitioning from “regular” anxiety to an anxiety disorder. If that is the case, you need to recognize it, and seek help, which is readily available, and quite effective.
Types of anxiety disorders
DSM-5 is the definitive manual which defines these disorders. This is the Diagnostic and Statistical Manual of Mental Disorders published by the American Psychiatric Association, and the new version has revisions published in 2013.
The broad category of anxiety disorders includes:
- Generalized Anxiety Disorder
- Social Anxiety Disorder (Social Phobia)
- Panic Disorder
- Panic Attack
- Specific Phobia
- Agoraphobia
- Separation Anxiety Disorder
- Substance/Medication-Induced Anxiety Disorder
- Selective Mutism
- Anxiety Disorder due to Another Medical Condition
- Other Specified Anxiety Disorder
- Unspecified Anxiety Disorder
As you can see, the list is long. There are several terms there which are familiar, and some which are highly technical. Don’t let that deter you. The broad symptoms discussed in my previous post referenced above can help you get a handle on the issues involved, enough to enable you to take the next step of seeking qualified help.
Other associated conditions
DSM-5 also has two other categories of disorders with some connections to anxiety disorders: Obsessive-Compulsive and Related Disorders and Trauma- and Stressor-Related Disorders. These have multiple conditions listed under them, but we will not delve further into those in this post. Obviously, psychiatrists are well-trained to recognize them and offer therapy.
Treatment
This obviously is the crucial issue.
The biggest road-blocks to therapy are diagnosis, inertia (including social stigma), and insurance coverage. Also important are co-morbidities, because anxiety disorders often co-exist with other mental and physical ailments. Finally, anxiety disorders and other mental illnesses can have symptoms which overlap. This can make it difficult to distinguish between various diseases.
Therapy for anxiety disorders is readily available and effective. It also covers a broad spectrum of options. Medications and psycho-therapy are the mainstays, but simpler remedies also have a role.
Exercise
Exercise clearly reduces stress and maintains mental fitness.
People who engage in regular, vigorous exercise are 25% less likely to develop an anxiety disorder or depression over the following five years.
Even a ten minute walk can improve anxiety and elevate a depressed mood for hours.
Obviously, the effects of exercise can vary, but it is clearly of benefit.
Alcohol, coffee, tobacco, drugs
There is very little doubt that cutting down on caffeine, stopping smoking, and stopping or reducing alcohol intake helps improve the symptoms of anxiety disorders. Several drugs, including prescription medications, can make these symptoms worse. Obviously, illegal drugs can contribute to this problem, too. The best way to deal with this is to discuss these issues with your doctor.
Sleep
Anxiety disorders commonly interfere with healthy sleep, and it is not unusual for sleep disorders to create anxiety and stress. What comes first is at times difficult to decide, since the two may co-exist. Again, it is important to obtain specialized help for such problems, and to establish good sleep hygiene.
Yoga & meditation
Many yoga asanas and poses reduce stress and muscle tension, and improve the symptoms of anxiety and depression. The deep breathing, slow breathing and controlled breathing elements widely taught in yoga practice bring about feelings of relaxation and a sense of calmness, and thus help people with several types of anxiety and panic disorders.
A Boston University School of Medicine study has revealed that brain scanning done immediately after a one hour yoga session shows a 27% increase in the levels of GABA in the brain. GABA is a chemical which helps transmit impulses in the brain, and low levels of GABA have been associated with anxiety and depression.
Obviously, this study does not prove yoga’s role in anxiety disorders, but it opens up interesting avenues for further research, and does provide useful leads.
Mindfulness meditation
Researchers from Johns Hopkins University, Baltimore, Maryland, published a study in the journal JAMA Internal Medicine in January 2014, where they analyzed 47 well-designed trials of meditation. Their findings suggest that mindfulness meditation can improve anxiety, depression, and pain.
Mindfulness meditation can be practiced as mindfulness-based stress reduction (MBSR) and mindfulness-based cognitive therapy (MBCT).
Essentially, the principles of mindfulness meditation are to train yourself to focus on the present and to be aware of your thoughts without judging yourself, all the while being conscious of breathing, and establishing a slow, deep rhythm of breathing.
Medications
There are several effective anti-anxiety medications on the market, and these are often necessary. Specific types of anxiety disorders may require different kinds of medicines, and a detailed analysis of these drugs is beyond the scope of this review.
In general terms, some of the groups of drugs used for anxiety disorders include the SSRIs (Selective Serotonin Reuptake Inhibitors), the SNRIs (Serotonin Neuroepinephrine Reuptake Inhibitors), the benzodiazepines, anti-seizure medications, and Tricyclic Antidepressants.
Don’t let these names scare you. A good physician should be able to guide you appropriately.
Herbal remedies and supplements
It is not uncommon for people to read about the latest cure on the internet, and start taking these herbs. This can be dangerous, as many of them have side effects, and they can interact with other prescription medications.
It is crucial to discuss matters with your doctor if you are planning to try any such remedies.
Psychotherapy/cognitive behavioral therapy
Counseling can help to improve symptoms of anxiety disorders.
Patients with anxiety disorders can often fall in a rut, with certain patterns of thought and behavior. Identifying these patterns, and then trying to understand and change them, is the principle behind cognitive behavioral therapy (CBT). This is a well-established and effective modality, which can show benefits in 12-16 weeks.
EMDR therapy
This is the short form for eye movement desensitization and reprocessing, a technique of psychotherapy which could be of benefit in treating post-traumatic stress disorder. The principle seems to be that some eye movements reduce the intensity of disturbing thoughts.
This is also being tested for the treatment of anxiety disorders.
Other research
New techniques continue to be evaluated for treating anxiety disorders. These include attentional training, motivational interviewing strategies, acceptance-based strategies, and virtual reality-based treatments.
Please get help!
Too many people struggle in silence all their lives with anxiety disorders. Too many lives are being damaged unnecessarily.
Healthcare professionals are standing by. Please let them help you.
thanks for this information. i have struggled for many years with an obsessive/compulsive problem of picking my thumbs(skin)to the point that they bleed frequently. i have tried many different medicines but the one that has helped me most is wellbutrin. i want to stop and think that i can but cannot. i do this more in the evenings for some reason. yes i try to walk at least 40 minutes 5 days a week. i can try some of these others as well.