What are Anxiety Disorders?
Anxiety disorders are common and affect all age ranges. They are potentially debilitating and at times difficult to diagnosis. Anxiety clearly comes from within us and is a distorted perception, irrational fear, or a phobia that can be all consuming. My dear friend and mentor Dr. Carl Hammerschlag speaks a great deal on psycho-neuro-immunology. It is not the event that causes the stress or anxiety but it is how we approach the event. The sudden death, the traumatic car accident, the inability to find something we have misplaced all can cause anxiety. If we approach the event in a frantic state, we will start a vicious cycle of our sympathetic nervous system. It will cause a cascade of systems. This feed back loop is responsible for all the anxious symptoms we experience.
What role does the sympathetic nervous system play in anxiety?
Our nervous system is an intricate system that is connected to a variety of mechanisms. In a “flight or fight” scenario we trigger out adrenal glands to release epinephrine and other neurotransmitters. This release stimulates our heart to race, and vasoconstricts or arteries in our extremities. This can cause a pale color, we also hyperventilate, blowing off carbon dioxide, which in turn causes our hands and feet to tingle, we may also experience light-headedness. It is not uncommon to have an urgency to void, our vision becomes blurred as our pupils dilate trying to take in all information. When we become aware of one or many of these symptoms, they exacerbate, making them worse with more of a release of epinephrine. In severe cases we feel as if we are having a heart attack and may seek out emergency treatment. Many health care providers in the emergency department will see a young adult, with chest pain and hyperventilation and not really give them the time of day. I have witnessed this personally numerous times. The health care provider leaves the room, rolls their eyes, and usually states something to this effect,” We have a psych case in room six, GREAT!” The lack of empathy, and understanding the fear the patient is experiencing is sadly all too frequent in this day and age.
What are the causes of Anxiety Disorders?
Causes are many. I do believe there could be a heredity component; physical illness should be ruled out. Some of the disorders that can cause a severe anxiety disorder are: Thyroid disorders, thyroid storm, adrenal tumors, pituitary tumors, recreational drug use, like cocaine and amphetamines, withdrawal from cannabis and other drugs, as well as heart arrhythmias’. A good health care provider should rule these out before progressing and assuming this is a pure anxiety disorder.
External causes can be misperception of the severity of the trauma, learned behavior by role models who suffer from anxiety. When a child is deathly afraid of insects, or water, there is a good chance that this was role modeled by their parents. A lack of healthy coping mechanisms, no experience in dealing with the stressor in the past, and poor self image. A bad previous experience can cause a reflection or flash back of that memory which in turn can elicit an attack. In marriage if one has had bad experiences with intimacy and later gets divorced and becomes involved in a new relationship, it would not be uncommon for an anxiety state to occur. This is very similar to a reaction formation. We react to a situation based on a bad past experience, or inappropriately learned behavior.
What are the treatments for anxiety disorders?
My dissertation in graduate school dealt with what are the most effective treatment modalities to treat panic disorder. This also pertains to anxiety disorders; we know medications in these cases are very useful. Anti-anxiety medication has an excellent result; however the patient as well as the provider does not want to keep them on this medication for long periods of time. The goal of treatment is to empower the patient to take control of their life. Sometimes the resolution can be as simple as explaining to the patient the sympathetic feedback loop and how that elicits anxiety. By understanding that they can stop it in many cases slows down the events or stops them. Please remember basic education is helpful, if your provider does not explain this, ASK. You are the consumer, you are paying for your care, you deserve an explanation what is wrong with you. If they are unsure then the provider needs to say, “ I am not sure, however I will refer you.”
Medications such as Xanax, Klonipin, and Valium all help in reducing the symptoms. Common side effects are fatigue, hypersomnia, a feeling of lethargy, and an increased sleep pattern. Close monitoring, and starting out at the lowest effective dose is very important. Behavioral therapy in conjunction with medication has the best results. There are many techniques that are effective. We will focus on the breathing/counting technique that has excellent success.
One teaches the patient how to take breathes, where one inspires through their nose and out through their mouth. They begin counting, as they breathe in, one, one thousand, two, one thousand and so on. When they reach the end of their inspiration and counting, they slowly, ever so slowly breathe out through their mouth. Again counting, one, one thousand, two, one thousand, and attempt to double the number they had for inspiration. Some individuals find out they are 4:8 breathers, others can manage a 5:10 count. Five seconds of inspiration to ten expirations. This technique offers distraction by counting, as well as a physiological response of slowing breathing down, while one’s heart rate decreases. This has been very effective in stopping an anxiety attack.
When one becomes proficient at this technique they will be able to do this in meetings, the classroom and before an exam without being noticed. This technique along with medication has a very high cure rate. One can slowly taper down the medication knowing with reassurance that they will be in control.
This technique has worked well for me and I still use it to de-stress. Meditation, yoga, and hypnosis all have been an excellent source to decrease anxiety attacks. Anxiety can be controlled without the sole use of medication. It takes commitment, patience and a want to take control of your life.