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Anxiety Disorder and Stress |
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1. What is an anxiety disorder? 2. What causes an anxiety disorder? 3. What do anxiety disorders lead to? 4.
What are the types of anxiety disorders? 5.
What types of specific treatment are available for anxiety disorders? 6.
How can family and friends help someone with an anxiety disorder? 1. What is an anxiety disorder? Anxiety is something we all feel from time to time. It is a common reaction we have to a threatening situation. An anxiety disorder, however, differs from normal anxiety in that the person can be subject to intense and prolonged feelings of fright and distress, often for no obvious reason. Feeling somewhat nervous before an exam is an example of normal anxiety. It may even enhance one's performance. When, however, one feels anxious months ahead of the exam and suffer from insomnia and, when the exam comes, one is so anxious one cannot write the exam, this can be considered an anxiety disorder. A mother, who worries excessively and continually about whether her child will return home safely from a normal day at school, could be considered to suffer from an anxiety disorder. Physical symptoms Psychological symptoms Muscle tension Tremors Palpitation Sweating Difficulty in breathing Dizziness Restlessness Urinary Frequency Diarrhea Worries Fear Uncertainty Irritability Tearfulness Poor concentration Forgetfulness Insomnia Feeling things are not real Anxiety disorders can affect all areas of our functioning, and they can mimic many other medical conditions, such as a heart condition. They are the most common of emotional disorders, occurring in about 1 of every 10 persons. They are more prevalent among women and appear even in children. Experiencing an anxiety disorder does not mean that one is going crazy, unstable, or weak in character. It is a medical condition, and, like other medical conditions such as hypertension, it responds well to the appropriate treatment. 2 What causes an anxiety disorder? While it is true that stresses in everyday life, such as work pressure and interpersonal conflicts, do contribute to anxiety disorders, research shows that they are related to a variety of biological and psychological factors. One's constitution and personality, together with one's upbringing and various life experiences, all contribute to this condition. Certain cultures which place high demands on their children may also unwittingly contribute to a high prevalence of anxiety disorders. Certain hormonal disturbances (such as a thyroid problem) can also manifest anxiety symptoms. At other times, the anxiety may accompany other medical conditions, or it can be a reaction to any illness. 3. What does an anxiety disorder lead to? When prolonged, the distress of an anxiety disorder may also lead to depression. Often the two co-exist. An anxiety disorder can also lead to physical problems, such as a peptic ulcer. Of course, the persistence of the symptoms themselves can interfere significantly with one's personal life and job performance. Some people seek relief by drinking or abusing other substances, which further complicates the problem. Anxiety disorders may be considered by some to be a mild form of emotional disorder, and the person is often seen as weak and shameful. This leads to an under-recognition of the person's anguish and it impedes the opportunity for effective treatment. 4. What are the types of anxiety disorders? Anxiety disorders can manifest in several forms. The five more common forms are described below. I.
GENERALIZED ANXIETY DISORDER 2
II. PANIC DISORDER Common symptoms in
a panic attack: Under such circumstances, a person may feel she is losing control or going crazy, and even think that she is going to die. She worries a lot about them and tries to avoid places or situations for fear they will trigger the trouble. This may lead to agoraphobia (avoidance of public spaces), which is described later. Panic disorder can be treated quite effectively with a combination of medications and psychotherapy. It is important to have it properly diagnosed and to follow a proper course of treatment. It is also useful to consider whether there are other stresses in one's life one needs to deal with more adequately. A phobia is an abnormally intense dread of a specific object or situations (which would not normally have that effect), and the dread is accompanied by a strong wish to avoid the feared object or situations. Three main phobic syndromes are usually recognized: agoraphobia, social phobias and simple phobias. Agoraphobia People with agoraphobia (fear of open spaces) become anxious when they leave home, mix with crowds, or are in situations that they cannot easily leave, such as when sitting in the middle of a row in a theatre. Suddenly the person becomes extremely anxious and rushes away. Recovery is almost always rapid thus reinforcing the habit of escape. When similar surroundings are entered again, the anxiety returns. As this sequence recurs, the symptoms appear in more places and the habit of avoidance grows. An anticipatory anxiety appears hours before the person has to go out, thereby adding greatly to the distress. In the most severe cases, the person cannot leave the house at all. Social phobia Persons with social phobias feel anxious in and avoid situations in which other people may observe them, like in restaurants, at parties, on public transport, in cinemas and places where they may have to speak in public. The anxiety may lead to blushing, trembling or nausea and they usually believe that other people notice these symptoms and this increases the anxiety. Similar to agoraphobia, a person with a social phobia anticipates the situation and often feels anxious well in advance. Simple phobias Many normal people find that a specific object or situation causes them unreasonable anxiety; height, thunderstorms, spiders and dogs are common examples. Other examples include fear of illness, flying, or excrement. Simple phobias are common among children. Sometimes, a phobia starts after a certain incident when the person is very disturbed. At other times such precipitating incidents cannot be identified, and in certain cases, the phobia may represent other fears which are repressed. Phobias can be effectively treated if the person is determined to overcome them. The determination is important to help the person through the necessary exposure to the feared object or situation. The anxiety can be overcome by allowing oneself to face up to the fear and stay with the fear until it subsides, and it will subside often within half an hour. This may be assisted by relaxation techniques and with the support of someone the person trusts. It may also be done in stages, by tackling the lessfeared situation first. IV. OBSESSIVE-COMPULSIVE DISORDER Obsessive-compulsive disorder (OCD) is a kind of anxiety disorder in which a person becomes trapped in a pattern of repetitive thoughts and behaviors that 4 are senseless and distressing but extremely difficult to overcome by logic or reason. If OCD becomes strong enough, it can severely limit a person's capacity to function. For example, a person with OCD may be troubled by repeated thoughts that he may have contaminated himself by touching doorknobs and other "dirty" objects. He may spend hours every day washing his hands until they are red and raw, leaving little time for other activities. Obsessions are repetitive thoughts or impulses while compulsions are repetitive behaviors. Obsessions and compulsions often occur together, with the compulsion being the means to cope with the anxiety generated by the obsession. For example, repetitive hand washing is a compulsion to cope with the fear of contamination, which is an obsession. Other examples of compulsion include endlessly rearranging objects to keep them in perfect alignment, or counting various things for no practical reason. Performing these actions may provide some relief from anxiety, but it is only temporary. People with OCD generally know that their obsessive thoughts are exaggerated, and that their compulsive behavior is not really necessary. This knowledge, however, is not sufficient to help them to break free of their habit even though they try to resist it. People with OCD tend to hide their problem rather than seek help because they may feel ashamed. The condition is hard to treat, partly because of the immense effort required by the person to change such thoughts and behavior patterns. Response-prevention is a behavioral treatment which refers to exposing oneself to situations that elicit the repetitive behavior and actively stopping oneself from carrying them out. For example, a compulsive hand-washer may be urged to touch an object believed to be contaminated, and then may be denied the opportunity to wash for several hours. The person gradually experiences less anxiety from the obsessive thoughts and becomes able to forgo the compulsive actions. Other techniques such as thought-stopping help the person to control certain repetitive thoughts by making a sound and ordering the thought to stop. Anti-obsessive medications have been used successfully to alleviate some of the symptoms, but a combination of medication and behavioral treatment yields much better results. V.
POSURAUMATIC STRESS DISORDER After the trauma of war, torture, rape and other crimes, natural disasters, car accidents and sexual or physical abuse, the following symptoms may appear: · feelings of extreme
fearfulness and helplessness after the initial trauma; Most of the time, PTSD develops shortly after the exposure to the traumatic event. Sometimes, however, it may be delayed months or even years and is then triggered by something that is reminiscent of the original stressor. Sometimes, a traumatic experience that lasted only a few minutes can leave an imprint for a lifetime. In many cases, however, the duration of symptoms is shorter. About half the persons who develop PTSD recover within the first three months. A minority continue to experience symptoms for many years. To suffer from PTSD, one may have been the victim oneself, one may have witnessed something terrible that happened to someone else, or one may have been confronted with the news of some horrible thing that happened to someone they love. Not everyone who is exposed to a terrible event goes on to develop PTSD. The likelihood depends on the nature of the individual and the nature of the event, and how a person deals with it. The treatment of PTSD involves the emotional reconnection with the traumatic experience in a supportive environment. The time when a person is ready to deal with it varies with the individual, and a person can be retraumatized if it is not handled properly. Skilled therapeutic help is often necessary. Certain effective psychotherapeutic strategies have recently been developed for this condition. Medications are also of some help in containing the symptoms. 5. What types of treatment are available for anxiety disorders? A clear diagnosis is most important. The doctor needs to rule out other medical conditions. The person needs to understand and accept the anxiety disorder. Treatment by the doctor will help but the more motivated one is to help oneself, the more successful one will be. There are different approaches to treating anxiety disorders and they can be used singly or in combination. One may use the services of health professionals, 6 such as family doctors, psychiatrists, psychologists, councilors, and social workers. There are also ways that one can help oneself and they are described under Self-help tips. Psychotherapy Talking with an understanding therapist can often help tremendously, and there are many different types of therapies which have been developed. One of the more commonly used therapies is cognitive behavioral therapy. In this therapy, it is believed that anxiety disorders are related to certain ways of thinking which are dysfunctional. These thinking patterns have developed over the years and are almost automatic. Examples include: · All-or-nothing thinking.
If one's performance falls short of perfect, one sees oneself as a complete
failure. By analyzing such thinking patterns, the therapist can help a person to change them and overcome the anxiety which is generated by them. Behavioral techniques such as exposure are often combined wherein a person is encouraged to behave in specific ways to counteract the symptoms. Other therapies include analytical psychotherapy which looks at deeper issues from the past that have contributed to the present problem, and supportive therapy which provides support for a person to cope with his condition. A therapist will often use a combination of appropriate strategies from different schools of therapies to help the person. Medications At times, an anti-anxiety drug is required when there are significant symptoms. Anti-anxiety drugs include tranquilizers, but there is the potential danger of dependency when they are not used properly. It is good practice not to use tranquilizers regularly for an extended period. Anti-anxiety drugs may also impair one's alertness. The person, together with the doctor, needs to assess whether use of these drugs would compromise driving a vehicle or operating machinery. Antidepressants are another group of medications which are of use, particularly the Selective Serotonin Reuptake Inhibitor (SSRI). While they do not have the danger of dependency, a person still needs to discuss with his doctor any side effects he may experience. Other medications, such as beta-blockers, may also be used to reduce palpitations and other physical manifestations of the anxiety disorder. Relaxation training Various types of relaxation skills are available, including breathing exercises, progressive muscular relaxation, the use of imagery, and meditation. One needs to learn the techniques, and to practice for some four to six weeks for them to be effective. A simple method is abdominal breathing: Sit comfortably with your feet planted on the ground and place you hands on your abdomen below your belly button. You may close your eyes and imagine a nice, relaxed scene. Focus on your breathing, allowing the air to come in through your nostrils and direct it to your lower abdomen. As you breathe in, your hands should rise with your abdomen as you inhale. Exhale slowly through your mouth, noting the abdomen fall. Two inches below your belly button is the special point in Chinese medicine known as the dantian. You can focus on it as the qi from each breath accumulates there. Lifestyle Often, the appearance of an anxiety disorder is a sign that one's lifestyle has not been the healthiest. Aside from developing more effective strategies to combat stress, one should also try to attain a balance in one's life by addressing issues of work and play, relationships and spirituality. Nutrition, exercise and one's daily routines are all areas that can be improved upon. Lifeskills Sometimes, anxiety may arise as a sign of certain skill deficits. Enhancing one's own skills will lead to significant improvement of the disorder. They include assertiveness training, expressing oneself appropriately, learning not to be too passive, nor too aggressive. Time management and organizational skills are also very valuable, especially in the workplace. Courses are offered in these areas from time to time in the community. Alternative Therapies Alternative or complementary approaches are often effective for anxiety disorders too. These include various bodywork approaches, such as massage therapy, and reflexology. Aromatherapy, such as using lavender and lemon essential oils, has been found to help a person relax in a most pleasant way. Herbs, both from the Western tradition (such as kava kava and St. John's Wort) and from the traditional Chinese medical tradition have also been used for anxiety symptoms. When using herbs and oils, consult qualified professionals and follow the proper instructions. Special therapeutic exercises like tai chi or qigong may be particularly helpful if one can find the right teachers. Acupuncture 8 and shiatsu, based on the meridian theory in Chinese medicine, may also relieve anxiety symptoms. Hypnosis and biofeedback are other techniques. These are tips that can be used when anxiety strikes. They are reproduced in a set of 10 flash cards (Hong Fook Health Cards) that one can carry in one's pocket. They are available from the Hong Fook Mental Health Association. I Body Scan. Check your body once over to detect any anxiety - your muscles, your breathing, your heartbeat, and your thinking - if so, make a conscious effort to resolve it. Make a commitment to your health. 2. Don't Forget to Breathe. Take a long and thin breath, in through your nose and out through your mouth, Direct the air to your "dantian", a point 2 inches below your belly button, and imagine good qi accumulating there. 3. Check Your Posture. Lift your head as if it were suspended by an invisible string attached to heaven. Drop your shoulders, straighten your spine and relax the whole body. Don't forget to smile! 4. One Speed. When you start to feel anxious, you may want to speed up whatever you're doing. Hold it and keep to one speed while driving, walking, eating or doing any other activity. 5. Press that Point. Locate Neiguan on the inner aspect of your forearm, 3 finger breadths below the wrist crease, in the midline between two muscle tendons. Knead this point with your thumb repeatedly for 3 minutes and allow the anxiety to subside. 6. What are the Odds? When apprehensive that something bad may happen, weigh objectively the chances of that happening. By accepting the rational assessment, your fear will lessen. Is it worth getting so upset over something so unlikely? 7. Worries and Worries. There are two types of worries: those that you can do something about, and those that you cannot do anything about. Do what you can for the first type, and try to put the second type away on a backburner, to be reviewed on another day. 8. Here and Now. At a moment of anxiety, try to concentrate on the here and now. If you are at a lecture, concentrate on the speaker; in the mall, try to notice the colors of people's clothes; when outside, look for shapes in the clouds up in the sky. 9 9. Visualize Success. When worried about the outcome of an endeavor, try to imagine how success would look like, and concentrate on that image for a while. This will increase the likelihood of a successful outcome. 10. Have Faith. For those with a religious belief, it is important to remember that you are being watched over by God, and you will not be sent any challenge bigger than you can handle. For those without a religion, it is also possible to gain strength from something bigger than oneself, such as nature.
6 How can family and friends help someone with an anxiety disorder? It is important for the family and friends of persons with an anxiety disorder to appreciate the suffering of their loved ones, and to not ridicule or humiliate them. Listening actively while refraining from giving advice is what they need. In some situations their complaints may be exaggerated, thus you should avoid giving in to their anxiety. For instance, a person with obsessive-compulsive disorder may ask a family member to do certain things for them to avoid their fear of contamination. It is important to resist the urge to help. They need to be supported in facing up to the symptoms and to overcome their illness in the most appropriate way. In other instances, the anguish of someone with post-traumatic stress disorder can be severe, and your compassion and understanding are very important. If they are not in treatment, it may be necessary to help them get into treatment. You should ask the doctor how you can best cooperate with the treatment plan. Anxiety disorders are an illness and they can be improved with treatment. Where to seek help? Consult your family doctor or obtain referral to a psychiatrist, or contact our intake staff. \ This material is prepared by Hong Fook Mental Health Association Main Office: 260 Spadina Avenue., Suite 408,Toronto, Ontario, M5T 2E4. Tel:(416) 595-1103 More copies of this booklet and the Hong Fook Health Cards are available upon request. i0 born 44% 5 Hong Fook Mental Health Association Toronto, Ontario, Canada May 2000 This is the English version of the booklet produced by the Hong Fook Mental Health Association to mark the Mental Health Week in May 2000. It is specifically designed by Dr. Ted Lo and the staff of Hong Fook Mental Health Association. |
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