Categorized | Anxiety, Stress Disorders

Living With Chronic Worry? You May Have a Generalized Anxiety Disorder

We all feel anxiety when we perceive there is a real threat to our safety, security and welfare.  For example, you worry that your child’s drug use may get him in trouble with the law. Or, for example, you worry that you are at risk for future health problems because of your smoking habit. These fears and worries may actually pose a real threat to you, at some future time. Thus, some anxiety is adaptive; it protects and warns you of possible danger and stimulates a fight-or-flight response in you, until you find a way to resolve the threat. Once you do, your anxiety about the problem ends.

But, there are people whose physical makeup predisposes them to chronic anxiety. They worry about everything, no matter how unreal the perceived threat seems to be. They have a Generalized Anxiety Disorder (GAD). But, their anxiety is in no way typical or adaptive. Their anxiety causes them significant distress and impairment throughout their daily life. They continually worry and anticipate bad things happening to them that can range from missing work deadlines to dying in a natural disaster. Their worries and fears make them ever more stuck in a vicious cycle of never-ending worry and anxiety.

People with GAD may seem neurotic, high-strung, and perfectionistic, because of their excessive worry and high need for control. Thus, it is easy to see people with GAD as having personality disorders that often have anxiety as a feature, like obsessive-compulsive disorder.  Also, people with GAD develop maladaptive ways to deal with their anxiety that make them seem neurotic and high strung. Nonetheless, GAD is a distinct syndrome that stems from  dysfunction in the parts of the brain that deal with fear, emotion and memory.

Researchers have known that the amygdala, a pair of almond-sized bundles of nerve fibers in the middle of the brain that help process emotion, memory and fear, are involved in anxiety disorders like GAD. But, until this new study that was conducted by researchers at Stanford University’s School of Medicine, researchers had not been able to peer closely at the nerve pathways that go to and from the subsections of this tiny brain area to other parts of the brain. They found scrambled connections between the parts of the brain that processes fear and emotion and the other brain regions (EScience.com).  Scrambled connections trigger anxiety, even when there’s no threat. Moreover, they found that by stimulating a distinct brain circuit in the amygdala, it counters rather than triggers anxiety and enhanced animals’ willingness to take risks (Amygdala circuitry mediating reversible and bidirectional control of anxiety). This discovery could lead to new treatments for anxiety disorders that deal specifically with the circuits in the amygdala. Until then, however, the mental health field has a range of treatments for anxiety that are very effective.

Treatment of GAD

Medication

The quickest way to reduce your anxiety is through medication. Today, the anti-anxiety medications work quickly, but, like most medications, they are not without side-effects. If you are going to seek treatment for your anxiety, you should know what the research says about medication versus psychotherapy for disorders of anxiety and depression. The research shows that medication and psychotherapy together work better than either treatment alone. Medication reduces your symptoms and permits new learning, because it lowers anxiety enough for you to take risks and implement healthier coping strategies.

The Selective Serotonin Reuptake Inhibitors (SSRIs) are usually psychiatrists’ first choice for treatment of anxiety, even though they are typically used as anti-depressants. This is because they are non-addictive and thus safer than traditional anti-anxiety medications (benzodiazepines). For optimal functioning, the mood stabilizing nerve chemical, serotonin, maintains a certain level within our nervous system and brain. Too much or too little causes brain dysfunction. In states of depression and anxiety, serotonin levels are often low. The SSRIs permit serotonin to circulate at higher levels in the nervous system and brain, which alleviates anxiety and depression and stabilizes mood.  The typical SSRIs used to treat anxiety are Lexapro and Paxil.

The Benzodiazepines include the well-known drugs Valium (diazepam), Xanax (alprazolam), Klonopin (clonazepam), and Ativan (lorazepam). They are no longer considered a first-line of treatment because, although they reduce anxiety quickly, they are addictive. Non-psychiatrists often treat anxiety with this class of drugs, but they are not trained to distinguish between the various psychiatric disorders. I would think very carefully, before you begin treatment with this class of medication. It’s the type of medication that requires you to continue taking more of it to alleviate your symptoms. Thus, developing an addiction is a risk with the benzodiazepines.

Buspar is another anti-anxiety medication that is neither an SSRI or benzodiazepine. However, like the SSRIs, it leaves more of the nerve chemical serotonin circulating in the body to alleviate anxious symptoms. But, unlike the SSRIs, buspar has little to no affect on sexual desire.

Psychotherapy

Anxiety is physiological. But, it can be lessened or worsened by the ways you cope with it. Thus, psychotherapy for anxiety disorders is very helpful, especially the psychotherapies that emphasize symptom management, like cognitive-behavioral therapy, mindfulness, and the stress-management therapies. Importantly, these therapies teach you ways to calm your brain and body, counter the irrational ideas that lead to excessive fear and worry, and learn better coping behaviors. If you’ve lived with anxiety for long, you have most likely reduced your world, to control some of your anxiety. A trained mental health professional can help you to replace the unhealthy ways that you’ve been controlling your fears and worries with behaviors that reduce your anxiety and open you to new experiences and learning.

Self-Care (Diet and Exercise)

Drink and food choice can trigger anxiety symptoms. Eating nutrient-deficient foods, not getting enough carbohydrates, protein or fat in your diet, or not eating enough can fluctuate blood-sugar levels that trigger anxiety. In particular, however, the omega-three fatty acids have been shown to be quite helpful in treating depression. More recently researchers have studied the relationship between the omega-three fatty acids and anxiety symptoms in substance abusers, as anxiety is a major cause of relapse from drug abstinence. They found that when these patients were given a high dose of omega 3 fatty acids (greater than 2 grams per day), there was a statistically significant reduction in anxiety compared to those receiving a placebo supplement. Moreover, the degree of the anxiety reduced was highly correlated to the decrease of the ratio of anti-inflammatory hormones to omega 3 fatty acids in the blood. It seems that the omega three fatty acids lower inflammation that has a positive effect on anxiety. Patients were able to handle stress better and had significant improvements in mood (Anxiety and Omega-Three Fatty Acids).

Exercise, when added to a program of cognitive-behavior therapy for the anxiety disorders, gives additional health benefits, and also extends the positive effects of psychotherapy treatment. Some studies have found that exercise  provides almost the same benefit as treatment with a medication. Researchers recommend exercise in the range of 30-40 minutes, three times per week, for anxiety reduction (PsychologyToday.com; Exercise and Mood). If you have interest, Authors Otto and Smit give you exercise strategies for managing your anxiety (Exercise Strategies, Amazon.com).

Do You Have A Generalized Anxiety Disorder?

The questions that follow meet the diagnostic criteria for a Generalized Anxiety Disorder (Diagnostic and Statistical Manual of Mental Disorders 4th Ed.; Washington DC: American Psychiatric Association, 2000). You may want to answer these questions, if you think you have a generalized anxiety disorder.

  1. Do you worry and are you fearful much of the time?
  2. Do you feel anxious, wound up, tense and restless, easily fatigued and worn-out, or have concentration and attention problems, or difficulty staying or falling sleeping ?
  3. If you answered “yes” to either question 1 or 2, have the symptoms been present most days over the past six months?
  4. Do you anticipate impending doom, even when there’s little basis to your fears?
  5. Do you struggle to regain control, or relax, or cope with your symptoms, but to no avail?
  6. Are your symptoms unrelated to another mental disorder?
  7. Do your symptoms cause you significant distress or problems functioning in your relationships, job, and other areas of your life, and these symptoms are not due to a substance or medical issue?
  8. Can you trace your anxiety symptoms back to your childhood?

If you answered yes to most of these questions, it’s best to get a Psychiatrist or Psychologist to help with diagnosing your symptoms. Anxiety is a symptom of many psychiatric and medical disorders. General medical practitioners and physician assistants do diagnose and treat anxiety conditions. But, they have not been trained to rule out the various addiction and personality disorders that have anxiety as a feature of the main problem, rather than the problem itself. So many times people are put on the wrong medications, because they went to a professional who did not accurately diagnose the problem. This adds to their anxiety and discomfort, as now they have to be weaned off the wrong medication, which takes time.

Remember, no two patients are alike. The reasons why one medication benefits one and harms another can vary greatly. When it comes to psychiatric disorders, only a licensed mental health professional has the education and training to diagnose and recommend appropriate treatments. And, when it comes to disorders that may be a result of an addiction or a serious medical condition, making the diagnosis requires sufficient education and training to make more subtle diagnostic distinctions as is necessary to many disorders, like GAD. Only the highest educated and trained of the mental health professionals, like a licensed Psychiatrist or Clinical Psychologist has this background.

I hope the information that I provide here today is helpful to you. I developed Psychology in Everyday Life to show you the many ways that psychology plays out in our daily lives, and also to make you an informed consumer of psychological services and treatments. The more you know about psychological conditions and options in treatments, the greater power you have over your psychological well being and health. After all, it’s your life. You should work in a collaborative fashion with your medical and mental health providers. The only way that you can do this is by becoming an informed consumer to the best of your ability.

If you found this post helpful, please say so by selecting the Like icon that immediately follows. Have a calm, peaceful and fear-free day. Warmly Deborah.

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