Meaning of Anxiety: A Holistic Approach
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| "Our anxiety does not come from thinking about the future, but from wanting to control it." - Kahlil Gibran |
What does ANXIETY mean? From my personal experience and with those that I have met, I have learned, and accepted, that stress and anxiety is as integral to our existence as bread and butter. It is WRONG to perceive anxious people as neurotic or weak, as NONE OF US is immune from it. It is also imperative for me to point out that stress and anxiety are NOT always harmful. In fact, these feelings are very crucial for our survival. They prepare us to face the uncertainties and enhance our performance in difficult tasks. So, when does this "normal" become a "disorder"? Let's find out.
Objectives of this article:
What anxiety disorder means
How to recognize anxiety disorders
Evidence-based anxiety treatment options
What does anxiety mean? How do you differentiate between everyday anxiety and an anxiety disorder?
An everyday anxiety and an anxiety disorder typically vary only in their frequency and severity of symptoms that is measured by the extent to which one's life is affected. A simple question that will make it clearer: Are you able to fulfill your daily responsibilities without much difficulty? If the answer is no, it is a disorder. Anxiety is a mental state of mind where our brain perceives something as a threat. That threat then transforms into physical symptoms such as sweating, fast and shallow breathing, headaches, chest pain, dizziness, shakiness, nausea. Our sympathetic nervous system takes control and stress hormone levels rise. We naturally engage in safety-seeking, comforting behaviors; we avoid circumstances that trigger stress and anxiety, which feeds on itself and reinforces the perception of threat. Over extended periods of time, this perception leads to severe physical symptoms like chronic fatigue, loss of concentration, insomnia. (Read: What is the Relationship Between Sleep, Stress and Nutrition?)
What are some of the challenges of diagnosing anxiety disorder?
In the very first meeting with the doctor, the patient's chief complaint is the physical symptoms they are experiencing, including tiredness, headaches, abdominal issues. The initial step, therefore, is to run a thorough physical examination. While it is established that anxiety causes physical symptoms, the vice versa if often very common as well where certain medical conditions lead to the development of anxiety, like lung disease, heart disease, diabetes, obesity. The other culprit is the medications that generate anxiety-like feelings. Some popular examples are steroids, decongestants, asthma and thyroid medications, and those used for the treatment of Parkinson's disease. Finally, it is important to rule out the existence of substance abuse that can cause anxiety, like alcohol and other drugs like cocaine and LSD. The next step involves checking the mental status of the patient. Why is the patient feeling unwell? Here it is important to address their lifestyle habits such as sleep, diet, exercise, personal events. While all of the factors mentioned above present as a challenge in diagnosing anxiety, the one factor that has a huge impact is the social stigma associated with being stressed and anxious. Patients find it difficult to admit to their doctors that they are struggling with anxiety; they don't want to seem vulnerable and neurotic; they feel they will not be heard seriously - their feelings will be outright dismissed. Therefore, it is extremely important for doctors to not jump to conclusions very early - they should first empathize and connect with their patients.
Just how disabling are anxiety disorders?
Anxiety disorders are extremely underestimated in their impact on a person's daily life. And to make the matters worse, there is a huge burden of the associated social stigma. According to research, social anxiety disorder feels worse than having a high blood pressure or diabetes. Generalized anxiety disorder feels worse than the above mentioned and asthma or any sort of heart condition. The worst is the obsessive-compulsive disorder, fairing poorer than all of the above conditions, including kidney disease. Can you imagine now how disabling anxiety is?
Is there a relationship between anxiety and depression?
Anxiety can present with symptoms that overlap with depression. Those diagnosed with an anxiety disorder will very commonly experience at least one episode of depression. Therefore, it is important for the healthcare professional to assess the presence of both. If the patient is successfully treated with antidepressants and are taken off the medications, there is an increased risk for the anxiety component to bounce back and become worse. Therefore, discontinuing treatment should be assessed with caution.
When is it recommended to meet a psychiatrist?
Psychiatric evaluation is warranted when the patient fails to respond to the interventions of the general practitioner (GP). Usually, the normal response time is between 6-8 weeks. Some factors that can complicate patient response is the co-presence of other conditions like personality disorders, bipolar disorders or substance use.
How can it be explained to the patient that they are dealing with an anxiety disorder?
First and foremost, show empathy. It takes 2-3 consults with the doctor before a patient is willing to accept that they are indeed dealing with anxiety. When the doctor has had meaningful conversations with the patient, and the patient has come to terms with the diagnosis, then is the correct time to provide medications and written materials for the patient to familiarize themselves with the condition. It is vital to develop a mutual understanding with the patient before the doctor refers them for a psychiatric evaluation or the chances are that those patients will never return to continue treatment.
What are some other suggestions for the patients to handle their anxiety?
While awaiting a formal diagnosis, patients are encouraged to adapt lifestyle modifications such as eating a healthy diet, exercising, minimizing alcohol intake, keeping track of caffeine intake, practicing mindfulness with meditation and breathing exercises. They can also use external health resources to learn more about their condition, which can be further discussed with their psychologist/psychiatrist.
Why is Cognitive Behavioral Therapy (CBT) most commonly recommended and what does it include?
CBT is backed by the greatest amount of research, clinical trials and meta-analyses that have concluded that it is most superior to other models in terms of its success rate. Typical CBT includes understanding the patient as a whole by asking what triggered the anxious feelings and what strategies they are implementing to cope with these feelings, and then formulating a treatment plan that is specifically tailored to their lifestyle and goals. Does the patient understand what they are going through? How do they solve their day-to-day life problems? CBT involves reshaping the patient's reasoning and thought processes to face their fears and challenge the thinking patterns. Behavioral techniques are also implemented in the treatment where the patient is gradually and increasingly exposed to their fears over time till the associated anxiety is reduced.
When are medications necessary and which ones are recommended?
General practice guidelines state that medications are opted for when patients are severely distressed and/or not responding to other interventions. Selective Serotonin Reuptake Inhibitors (SSRIs) are the most widely recommended first-line treatment globally. The second-line class of medications is the Serotonin- Norepinephrine Reuptake Inhibitors (SNRIs). The initial treatment begins with SSRI monotherapy for 1-2 weeks, typically starting with half the dose of what is prescribed for depression, accounting for the fact that anxious and stressful patients are hypersensitive. For the next 4-6 weeks, medication response is monitored. If the response is positive, the same treatment continues for 6-12 months. If the response is negative, either the medication dose is adjusted or an alternate medication is started. Other classes of medications, such as beta blockers, benzodiazepines and antipsychotics, should NOT be used as first-line treatments due to their side effects (*Note: Medications are given in combination with CBT*).
What to look for if the patient is not responding to treatment:
Discuss with the patients about their lifestyle habits or any related factors that might be playing a role. Are they compliant with their medications? The medication dose can also be reviewed and adjusted. Are there any unhealthy/stressful situations at home or work? Patients can be encouraged to meet with their psychologist/psychiatrist more frequently to maintain the treatment momentum. Lastly, check in on any other medical conditions that the patient may be mismanaging and inducing anxiety as a result.
Some strategies to maintain mental health:
Regular exercise
Balanced, healthy diet
No smoking
Maintenance of a good sleep hygiene
Socialization
Anxiety can be debilitating and distressing and bringing it to the attention of a healthcare professional should never be dismissed due to social stigmas. Why should you ever be in control of your thought processes? Anxiety disorders have a high recovery rate and they CAN be managed successfully. I encourage you to consult with your doctor if you feel your lifestyle is severely compromised due to certain fears or thoughts. If you are looking for more related resources that can help you combat anxiety, please leave your comment below and connect with me.
Read: What is the Relationship Between Sleep, Stress and Nutrition?
References:
1. Andrews et al, British Journal of Psychiatry (1998); 173: 123-131.
2. RANZCP clinical practice guidelines for the treatment of panic disorder, social anxiety disorder and generalised anxiety disorder 2018.
3. Craske, uptodate.com, Psychotherapy for generalised anxiety disorder 2018.
4. Australian Medicines Handbook 2018.
5. Maudsley prescribing guidelines in psychiatry, 13thedition, 2018.
