“Doctor, I am feeling very uneasy and restless. There are a lot of thoughts crowding my brain. I just cannot concentrate on anything. I am unable to distract myself… I don’t know how to explain it to you. I am having trouble sleeping. I wake up in the middle of the night, feeling as if there is something heavy on my chest. Please help me stop these thoughts.”
A visibly scared, soft spoken, young woman, age 27, sat in front of me. When I asked what triggers these thoughts, she said, “Anything. Primarily these thoughts are about what will happen next or in the future. They are accompanied by palpitations, sweating of palms, etc.”
This young woman has been under the treatment of a psychiatrist for what is called anxiety disorder. Along with medicines, she had recently started psychotherapy with me.
According to the American Psychological Association, Anxiety is defined as: It is an emotion characterized by feelings of tension, worried thoughts and physical changes like increased blood pressure. People with anxiety disorders usually have recurring intrusive thoughts or concerns. They may avoid certain situations out of worry. They may also have physical symptoms such as sweating, trembling, dizziness, rapid heartbeat, dry mouth, nausea, or dizziness.
TYPES OF ANXIETY DISORDERS
- Generalized Anxiety Disorder (GAD): Chronic, excessive and uncontrollable worry about anything or everything.
- Panic Disorder: Greatly magnified anxiety attack of sudden onset.
- Phobic Disorder: Marked fear and avoidance of specific objects or situations.
- Obsessive Compulsive Disorder (OCD): Recurrent intrusive thoughts, images or impulses and repetitive behaviors aimed at reducing distress.
- Posttraumatic Stress Disorder (PTSD): Persistent re-experiencing of trauma in the form of dreams or flashbacks.
CAUSES
Genetic Causes:
Experiments with animals have shown that heredity has strong influence on characteristics such as timidity, fearfulness and aggressiveness. Anxiety disorders tend to run in families. Children of people treated for anxiety disorders tend to be more anxious and fearful, have more difficulties at school, worry more about family and themselves, and have more physical complaints than compared to children of normal parents.
Brain Function:
Fear, an emotion evolved to deal with danger, causes an automatic, rapid protective response that occurs without the need for conscious thought. The body’s fear response is coordinated by a small structure deep in the brain called amygdala. Abnormal activation of particular parts of the amygdala takes place in different types of anxiety disorders. This is commonly known as ‘triggering’ of amygdala. With anxiety experiences, the amygdala becomes hypersensitive and gets triggered easily even by lower intensity stimulus. Another part of the brain called the hippocampus plays an important role in emotion laden memories. The hippocampus was seen to be reduced in size in traumatized individuals. Cortisol, a hormone which regulates how an individual responds to stress, is influenced by prior exposure to high levels of stress.
TREATMENT
- Drug Therapies
- Psycho Therapies
A. BEHAVIOR THERAPIES
In vivo exposure: Experiencing actual feared situation rather than imagined. It is done gradually and under the guidance of a therapist.
Flooding: Intense and rapid exposure.
Modelling: It emphasizes acquiring behavioral skills and a feeling of competence while dealing with anxiety provoking situations.
B. COGNITIVE THERAPIES
The two most important and widely used successfully cognitive therapies are Rational Emotive and Cognitive Behavioral Therapy by Dr Albert Ellis and Cognitive Behavioral Therapy by Dr Aaron Beck.
Dr Beck believes that the core psychological problem in anxiety disorders is the vulnerability that grows out of an individual’s tendency to devalue his or her problem-solving ability and his tendency to exaggerate the degree of threat in problematic situations. Such an individual perceives threats to social relationships, freedom and self-identity.
Cognitive restructuring is an important technique in REBT where an individual’s attention is called towards unrealistic thoughts that influence maladaptive behaviors and unhealthy emotions. The therapist helps the individual to review their irrational beliefs and develop rational thoughts and beliefs. During therapy, emphasis is placed on how irrational things that people say to themselves can affect their emotions and behavior.
A therapist does not provide overnight cures with the above therapies. Usually, the process of reducing the emotional response is gradual.
In our country, physical illness is well accepted and treated without thinking about the cost. It is important to understand that our mind is a vital part of our body and needs the same amount of care. Seeking professional help for mental health illness should not be seen as an attention seeking behavior or a problem only of the weak and the rich. Nor is it a taboo. Empathizing with people in distress and seeking timely and appropriate help is now the need of the hour.
