We can see that the response to stress can itself be distressing. The physical changes may be alarming, or the emotional or behavioural changes may make it harder to cope. When the natural stress response causes more stress in this way, a cycle is established. The maintenance of such cycles is the root of all forms of anxiety-related problem. In order to break the pattern, it is necessary first to identify the cycles that keep you feeling anxious.
The physical experience of anxiety can be alarming, especially if it's misinterpreted. For example, respiratory changes may be interpreted as 'I can't breathe', or light-headedness as 'I'm going to collapse'. If the symptoms are extreme they can generate a fear of the symptoms themselves. Physical symptoms such as shaking or sweating can also affect you, undermining your confidence and making the symptoms worse. In each case the stress response produces more stress.
Psychological maintaining cycles Anxiety-related problems tend to be associated with an overestimation of danger coupled with an underestimation of your own coping resources. This 'biased thinking' can lead to more distress, which then makes your perception of the situation and your ability to cope even more distorted. There are a number of common 'thinking biases'.
Catastrophizing is anticipating disaster as the only outcome. It's particularly associated with physical symptoms - for example, chest pain may be perceived as a heart attack.
Black-and-white thinking means seeing everything in all-or-nothing terms, for example 'I always feel this bad,' rather than 'I feel bad at the moment but could get better with help.' A common form of black-and-white thinking is expecting perfection in yourself, and feeling that if something isn't perfect you have failed.
Exaggerating is the process of magnifying the negative or frightening aspects of your experiences. It is often associated with overgeneralizing and jumping to alarming conclusions.
Ignoring the positive is the process of mentally filtering out positive and reassuring facts and events, for example not noticing compliments or acknowledging achievements.
Scanning is searching for the thing you fear, which can increase the likelihood of encountering that thing, as well as resulting in false alarms.
Mood changes can also affect the ability to cope with stress. Constant anxiety can be demoralizing and create a feeling of hopelessness, which then undermines your coping ability.
Behavioural maintaining cycles It's natural to respond to danger by fleeing from it or avoiding it. However, avoidance of danger that isn't real but only perceived can keep anxiety going because it prevents you from learning to cope. Avoidance may be direct (for example, not going out in public), but can also take other forms. One common avoidance behaviour is using stimulants, such as cigarettes, tea or coffee, in response to stress. This is counterproductive because the nicotine or caffeine encourages the release of adrenaline, which promotes further stress symptoms. Alcohol, too, though a sedative in the short term, becomes a stimulant when it is metabolized. If food or drugs are used as a long-term coping strategy they can cause physical changes which themselves become a source of anxiety.
Another behavioural cycle is the constant seeking of reassurance. Although assurance is useful if it helps you to deal with your fears, it's not helpful if you don't accept the reassurance and have to keep going back to hear it again. This can also put a strain on relationships.
Some people are very sensitive to worries and anxieties, while others seem a lot more robust. Understanding 'why me?' can put the problem in perspective and also help you to see where changes need to be made in your lifestyle, outlook and attitudes. There are various 'risk factors' that may make you more prone to anxiety problems.
Personality type is a rather controversial factor, but many agree that certain characteristics seem to be linked to anxiety-related problems. 'Type A' personalities have been identified by cardiologists as having an increased risk of high blood pressure and other stress-related symptoms. These personalities are characteristically competitive and ambitious, with a tendency to ignore symptoms of stress. However, it has also been found that such people are able to change their behaviour and so reduce the problems they previously experienced.
Studies have shown that anxiety disorders can run in families, although it's difficult to know whether this is caused by genetic factors or whether it's a result of family members communicating behaviour to each other. But, even if there is a strong trend in your family, this doesn't mean it is not possible for you to overcome a tendency to worry.
Emotional and psychological problems are often linked with stressful life events, such as an accident, or with long-term stresses such as illness or financial problems. A life event does not have to be unpleasant to cause stress: any change that requires readjustment - such a moving house, or a new baby - can be stressful. Life events in the past, such as childhood trauma, can also affect the way we respond to situations in the present.
People with a psychological tendency towards biased thinking (see above) are more at risk of developing anxiety-related problems. Mood also affects the way we see things: if we are unhappy we are more likely to be prone to distorted or biased thinking.
Another strong factor in our vulnerability to psychological problems is the degree of social support we have. The greater our social support, the more protected we are against trauma and stress, so your risk of developing worries and anxieties can be modified by a change in your social situation. An ideal social support network is a combination of non-intimate friendships and close friends.
Our vulnerability to anxiety is usually determined by a combination of elements rather than a single factor. Developing an overview of your personal situation can help to identify your own risk factors and the maintaining cycles (see above) that apply to you. Your problems will make sense in the context of your own history and current situation. Most people, at some time in their lives, experience levels of fear or anxiety that cause difficulties - at any given time, one in ten people are suffering from an anxiety disorder. Often this is temporary, but sometimes help is required to reverse the changes.
Forms of Anxiety Disorder
Health professionals classify emotional or psychological problems in order to describe them succinctly and to identify appropriate treatment options. The following are the most common diagnoses of problems related to fear, worry or anxiety.
Phobias A phobia is a fear that is inappropriately intense and/or which may lead to avoidance and affect your quality of life. Phobias generally don't diminish over time because the sufferer tends to avoid the thing he or she fears. There are three main types of phobia. Simple phobias are fears of specific objects or situations (brontophobia, for example, is the fear of thunder). Social phobias are fears of a range of situations where you may be exposed to evaluation (such as public speaking). Agoraphobia is the fear of leaving a place of safety. It is often associated with panic (see below) because the fear response is very powerful.
Panic A 'panic attack' is an intense feeling of apprehension coupled with a very powerful physical reaction. Sufferers sometimes find themselves fighting for breath, experiencing chest pains, unable to see clearly and feeling very frightened. Overbreathing, or hyperventilation, is a common experience during panic, and it produces even more distressing symptoms, such as dizziness and ringing in the ears. There can be a wide range of triggers for a panic attack. Panic frequently occurs in combination with other anxiety disorders and is often made worse by the sufferer jumping to frightening conclusions.
Generalized Anxiety Disorder Generalized Anxiety Disorder (GAD) describes persistent, pervasive feelings of anxiety that give rise to what seems like constant physical and mental discomfort. Sufferers feel as if they are perpetually on edge. GAD is thought to be underpinned by many different worries, or by the misinterpretation of a wide range of situations as threatening.
Obsessive Compulsive Disorder Obsessive Compulsive Disorder (OCD) describes a compulsion to carry out particular acts or to dwell on certain mental images or thoughts in order to feel at ease. So you might feel compelled to repeatedly check that switches or turned off, or to repeat reassuring phrases to ensure the safety of members of your family. A perceived threat triggers a worrying thought, and this compels the sufferer to carry out a reassuring mental or physical activity. Often OCD is maintained by avoidance: for example, you might restrict the behaviour of your children out of fears about their welfare, and thereby never learn that those fears are bearable.
Physical problems and hypochondriasis
Sometimes physical symptoms are the first sign that we are overstressed. Typical physical symptoms are difficulty with sleeping, stomach and digestive problems, raised blood pressure, difficulty in swallowing, nausea and diarrhoea.
Hypochondriasis refers to distress in response to perceived symptoms. It is often associated with extra sensitivity to normal bodily sensations and/or a preoccupation with the fear of catching a serious disease. The worries are so strong that sufferers tend to be resistant to reassurance, despite constantly seeking reassurances. The problem is maintained by constant checking for signs of illness.
Burn-out This is a recently coined term for a reaction to constant stress that tends to go unnoticed until the sufferer, or someone close, realizes that he or she is not coping. The symptoms are similar to those of other anxiety-related disorders, but tend to be more pronounced because the stress is ignored until it has become quite severe.
Post-Traumatic Stress Disorder Post-Traumatic Stress Disorder (PTSD) is a stress reaction that follows unusually traumatic events. The main features, accompanied by classic symptoms of anxiety, are recurrent, vivid memories or dreams of the event. Sometimes the effect is a deadening of the emotions. Usually the PTSD response fades without intervention, but for some people it becomes a longer-term problem, particularly if they avoid places or issues that stimulate memories of the traumatic event.
Symptoms of Generalized Anxiety Disorder symptoms can vary.
They can include:
- Restlessness and feeling keyed up or on edge
- Difficulty concentrating or your mind "going blank"
- Muscle tension or muscle aches
- Trembling, feeling twitchy or being easily startled
- Trouble sleeping
- Sweating, nausea or diarrhea
- Shortness of breath or rapid heartbeat
- Constant worrying or obsession about small or large concerns
- Feel overly anxious to fit in
- Be a perfectionist
- Lack confidence
- Redo tasks because they aren't perfect the first time
- Strive for approval
- Require a lot of reassurance about performance
When to see a doctor or therapist
Some anxiety is normal, but see your doctor if:
- You feel like you're worrying too much, and it's interfering with your work, relationships or other parts of your life
- You feel depressed, have trouble with drinking or drugs, or you have other mental health concerns along with anxiety
- You have suicidal thoughts or behaviors — seek emergency treatment immediately
As with many mental health conditions, what causes generalized anxiety disorder isn't fully understood. It may involve naturally occurring brain chemicals (neurotransmitters), such as serotonin, dopamine and norepinephrine. It's likely that the condition has several causes that may include genetics, your life experiences and stress.
Some physical health conditions are associated with anxiety.
- Heart disease
- Hypothyroidism or hyperthyroidism
- Gastroesophageal reflux disease (GERD)
- Gastro-intestinal problems
Things that may increase your risk of developing generalized anxiety disorder include:
- Being female. More than twice as many women as men are diagnosed with generalized anxiety disorder (due to hormone imbalance).
- Childhood trauma. Children who endured abuse or trauma, including witnessing traumatic events, are at higher risk of developing generalized anxiety disorder at some point in life.
- Illness. Having a chronic health condition or serious illness, such as cancer, can lead to constant worry about the future, your treatment and your finances. Thyroid problems may lead to anxiety.
- Stress. A big event (Abuse/Separation/Divorce) or a number of smaller stressful life situations may trigger excessive anxiety.
- Personality. People with some personality types are more prone to anxiety disorders than are others. In addition, some personality disorders, such as borderline personality disorder, also may be linked to generalized anxiety disorder.
- Genetics. Generalized anxiety disorder may run in families.
- Substance Abuse. Drugs and alcohol abuse can worsen generalized anxiety disorder (especially street drugs). Caffeine and nicotine also may increase anxiety.
Generalized anxiety disorder does more than just make you worry. It can also lead to, or worsen, other mental and physical health conditions, including:
- Substance abuse
- Trouble sleeping (insomnia)
- Digestive or bowel problems
- Teeth grinding (bruxism)
- Substance use disorders
Treatments and Drugs
The two main treatments for generalized anxiety disorder are medications and psychotherapy. You may even benefit more from a combination of the two. It may take some trial and error to discover exactly what treatments work best for you.
Several different types of medications are used to treat generalized anxiety disorder:
- Antidepressants. These medications influence the activity of brain chemicals (neurotransmitters) thought to play a role in anxiety disorders. Examples of antidepressants used to treat generalized anxiety disorder include Paroxetine (Paxil), sertraline (Zoloft) and venlafaxine (Effexor).
- Buspirone or Venlafaxine (Effexor) These anti-anxiety medications may be used on an ongoing basis. As with most antidepressants, it typically takes up to several weeks to become fully effective. A common side effect of buspirone is a feeling of lightheadedness shortly after taking it; for Venlafaxine it is a headachy feeling. Less common side effects include stomach aches, headaches, nausea, nervousness and insomnia.
- Benzodiazepines. In limited circumstances your doctor may prescribe one of these sedatives for short-term relief of anxiety symptoms. Examples include lorazepam (Ativan), diazepam (Valium), chlordiazepoxide (Librium) and alprazolam (Xanax). Benzodiazepines are generally only used for relieving acute anxiety on a short-term basis. They can be habit forming and can cause a number of side effects, including drowsiness, reduced muscle coordination, and problems with balance and memory.
Also known as talk therapy and psychological counseling, psychotherapy involves working out underlying life stresses and concerns and making behavior changes. It can be a very effective treatment for anxiety.
Cognitive behavioral therapy is one of the most common types of psychotherapy for generalized anxiety disorder. Generally a short-term treatment, cognitive behavioral therapy focuses on teaching you specific skills to identify negative thoughts and behaviors and replace them with positive ones. Even if an undesirable situation doesn't change, you can reduce stress and gain more control over your life by changing the way you respond.
Coping and Support
To cope with generalized anxiety disorder, here are some things you can do:
- Join an anxiety support group. Here, you can find compassion, understanding and shared experiences. You may find support groups in your community, and there are also several available on the Internet.
- Take action. Work with your mental health provider to figure out what's making you anxious and address it. For example, if finances are your concern, work toward drawing up a budget.
- Let it go. Don't dwell on past concerns. Change what you can and let the rest take its course.
- Break the cycle. When you feel anxious, take a brisk walk or delve into a hobby to refocus your mind away from your worries.
- Stick to your treatment plan. Take medications as directed. Keep therapy appointments. Consistency can make a big difference, especially when it comes to taking your medication.
- Socialize. Don't let worries isolate you from loved ones or enjoyable activities. Social interaction and caring relationships can lessen your worries.
Lifestyle and Home remedies
While most people with generalized anxiety disorder need psychotherapy or medications to get anxiety under control, lifestyle changes also can make a difference. Here are a few things that you can do:
- Get daily exercise. Exercise is a powerful stress reducer, can improve your mood and can keep you healthy. It's best if you develop a regular routine and work out most days of the week. Start out slow and gradually increase the amount and intensity of exercise.
- Eat a healthy diet. Avoid fatty, sugary and processed foods. Include foods in your diet that are rich in omega-3 fatty acids and B vitamins.
- Avoid alcohol, street drugs, and other sedatives. These can worsen anxiety.
- Use relaxation techniques. Visualization techniques, meditation and yoga are examples of relaxation techniques that can ease anxiety.
- Make sleep a priority. Do what you can to make sure you're getting enough quality sleep. If you aren't sleeping well, see your doctor, and get a perscription for a mild sleeping pill as without sleep you can not function effectively.
In-Depth Generalized anxiety disorder Definition
- Mental health: What's normal, what's not Mental health vs. mental illness — Find out how mental illnesses are diagnosed and defined.
- Borderline personality disorder Borderline personality disorder — Comprehensive overview covers symptoms, causes, treatment and self-care strategies.
- Depression (major depression) Depression — Comprehensive overview covers symptoms, treatment and coping with this mood disorder.
- Stress symptoms: Effects on your body and behavior Stress symptoms — Learn how stress can affect your health so that you can take action.
- Mental illness in children: Know the signs Mental illness in children — Find out how to tell if your child needs help.
- Mindfulness exercises: How to get started Mindfulness exercises — Understand ways to practice mindfulness.
- Mental health: Overcoming the stigma of mental illness Mental health: Recognize and cope with the stigma of mental illness.
- Anxiety and Depression Association of America: Understanding the facts http://www.adaa.org/understanding-anxiety
- American Psychiatric Association http://www.psych.org/
- Mental Health America: Anxiety disorders http://www.nmha.org/go/information/get-info/anxiety-disorders
- National Institute of Mental Health: How to get help for anxiety disorders http://www.nimh.nih.gov/health/publications/anxiety-disorders/how...