Anxiety

Anxiety is an unpleasant state that involves a complex combination of emotions that include fear, apprehension, and worry. It is often accompanied by physical sensations such as heart palpitations, nausea, chest pain, shortness of breath, or tension headache.

Anxiety is often described as having cognitive, somatic, emotional, and behavioral components (Seligman, Walker & Rosenhan, 2001). The cognitive component entails expectation of a diffuse and uncertain danger. Somatically the body prepares the organism to deal with threat (known as an emergency reaction): blood pressure and heart rate are increased, sweating is increased, bloodflow to the major muscle groups is increased, and immune and digestive system functions are inhibited. Externally, somatic signs of anxiety may include pale skin, sweating, trembling, and pupillary dilation. Emotionally, anxiety causes a sense of dread or panic and physically causes nausea, and chills. Behaviorally, both voluntary and involuntary behaviors may arise directed at escaping or avoiding the source of anxiety. These behaviors are frequent and often maladaptive, being most extreme in anxiety disorders. However, anxiety is not always pathological or maladaptive: it is a common emotion along with fear, anger, sadness, and happiness, and it has a very important function in relation to survival.

Neural circuitry involving the amygdala and hippocampus is thought to underlie anxiety (Rosen & Schulkin, 1998). When confronted with unpleasant and potentially harmful stimuli such as foul odors or tastes, PET-scans show increased bloodflow in the amygdala (Zald & Pardo, 1997; Zald, Hagen & Pardo, 2002). In these studies, the participants also reported moderate anxiety. This might indicate that anxiety is a protective mechanism designed to prevent the organism from engaging in potentially harmful behaviors.

Treatment of anxiety

Prescription medication

The acute symptoms of anxiety are most often controlled with anxiolytic agents such as benzodiazepines. Diazepam (Valium) was one of the first such drugs. Today there are a wide range of anti-anxiety agents that are based on benzodiazepines, although only two have been approved for panic attacks, clonazepam (Klonopin) and alprazolam (Xanax). All benzodiazepines may induce dependency, and extended use should be carefully monitored by a physician, preferably a psychiatrist. It is very important that once placed on a regimen of regular benzodiazepine use, the user should not abruptly discontinue the medication.

Some of the selective serotonin reuptake inhibitors (SSRIs) have been used with varying degrees of success to treat patients with chronic anxiety, the best results seen with those who exhibit symptoms of clinical depression and non-specific anxiety or general anxiety disorder concurrently. Beta blockers are also sometimes used to treat the somatic symptoms associated with anxiety, especially the shakiness of "stage fright." According to publications written on stage fright and nervousness with musicians, Beta Blocker therapy has proven helpful.

The addictive nature of the benzodiazepine class became apparent in the mid 1960s when Valium (Diazepam), the first drug in the class to win FDA approval, resulted in thousands of people who quickly showed the classic symptoms of addiction when used for more than a week or two consistently. However, other scientific research indicates that "the vast majority of the use of benzodiazepines is appropriate".

Cognitive-behavioral therapy

Cognitive-behavioral therapy (CBT) is a form of psychotherapy often recommended for the treatment of anxiety disorders. The goal of the cognitive-behavioral therapist is to decrease avoidance behaviors and help the patient develop coping skills. Each individual's therapy is unique; however, there are common components in Cognitive Behavior Therapy treatment of an Anxiety Disorder. Education about a particular Anxiety Disorder and how it is interfering in key areas of life must be addressed first. Treatment may begin by addressing "readiness" issues or "treatment interfering behaviors". This may entail:

• Challenging false or self-defeating beliefs
• Developing a positive self-talk skill
• Developing negative thought replacement
• Systematic desensitization, also called exposure (used for agoraphobia, phobias, panic disorder, and OCD mainly)
• Providing knowledge that will help the patient cope (For example, someone who suffers from panic may be informed that fast, prolonged, heart palpitations are in themselves harmless.)

Other coping strategies

Supplements

Template:OR A variety of over the counter supplements and medications are also used for their alleged anti-anxiety properties; however, there is little scientific evidence to back up these claims.

• Rhodiola rosea - used in Scandinavian countries to reduce stress and anxiety.
• Kava - a popular herbal treatment; small doses either taken regularly through the day or when early symptoms are noticed by the patient.
• Valerian root - also reputed to have anti-anxiety and sedative properties.
• passion fruit
• passion flower - has a mild tranquilizing effect without being sedating, a useful adjunct to programs of stress reduction.
• St. John's wort - The flowers and leaves of the St John's Wort plant (Hypericum perforatum) are used to make the herbal remedies. These flowers and leaves contain many different compounds including hypericin, which is thought to be one of the compounds that makes some people believe that St John's Wort is helpful for depression and anxiety.
• Hops - alleged to have a relaxing and sedative effect on the central nervous system, may also ease cravings for alcohol
• Chamomile
• B-complex
• L-Tryptophan and 5-HTP - Precursors used by the body for the synthesis of serotonin
• GABA

Alternative medicine

A 2002 CDC survey (see table 3 on page 9) found that complementary and alternative methods were used to treat anxiety/depression by 4.5 percent of U.S. adults who used CAM.

Theories

Two factor theory of anxiety

Template:Original research Sigmund Freud recognized anxiety as a "signal of danger" and a cause of "defensive behavior". He believed we acquire anxious feelings through classical conditioning and traumatic experiences.

We maintain anxiety through operant conditioning; when we see or encounter something associated with a previous traumatic experience, anxious feelings resurface. We feel temporarily relieved when we avoid situations which make us anxious, but this only increases anxious feelings the next time we are in the same position, and we will want to escape the situation again and therefore will not make any progress against the anxiety.

Types of anxiety

Existential anxiety

See more under existential crisis.

Theologians like Paul Tillich and psychologists like Sigmund Freud have characterized anxiety as the reaction to what Tillich called, "The trauma of nonbeing." That is, the human comes to realize that there is a point at which they might cease to be (die), and their encounter with reality becomes characterized by anxiety. Religion, according to both Tillich and Freud, then becomes a carefully crafted coping mechanism in response to this anxiety since they redefine death as the end of only the corporal part of human personal existence, assuming an immortal soul. What then becomes of this soul and through what criteria is the cardinal difference of various religious faiths.

Philosophical ruminations are a part of this condition, and this is part of obsessive-compulsive disorder. They are typically about sex and religion or death.

According to Viktor Frankl, author of Man's Search for Meaning, when faced with extreme mortal dangers the very basic of all human wishes is to find a meaning of life to combat this "trauma of nonbeing" as death is near and to succumb to it (even by suicide) seems like a way out.

Test anxiety

Test anxiety is the uneasiness, apprehension, or nervousness felt by students who have a fear of failing an exam. Students suffering from test anxiety may experience any of the following: the association of grades with personal worth, embarrassment by a teacher, taking a class that is beyond their ability, fear of alienation from parents or friends, time pressures, or feeling a loss of control. Emotional, cognitive, behavioral, and physical components can all be present in test anxiety. Sweating, dizziness, headaches, racing heartbeats, nausea, fidgeting, and drumming on a desk are all common. An optimal level of arousal is necessary to best complete a task such as an exam; however, when the anxiety or level of arousal exceeds that optimum, it results in a decline in performance. Because test anxiety hinges on fear of negative evaluation, debate exists as to whether test anxiety is itself a unique anxiety disorder or whether it is a specific type of social phobia.

While the term test anxiety refers specifically to students, many adults share the same experience with regard to their career or profession. The fear of failing a task and being negatively evaluated for it can have a similarly negative effect on the adult.

Stranger anxiety

Stranger anxiety is not a phobia in the classic sense; rather it is a developmentally appropriate fear by young children of those who do not share a 'loved-one', caretaker or parenting role.

Anxiety in palliative care

Some research has strongly suggested that treating anxiety in cancer patients improves their quality of life. The treatment generally consists of counseling, relaxation techniques or pharmacologically with benzodiazepines.

Sources

• Rosen, J.B. & Schulkin, J. (1998): "From normal fear to pathological anxiety". Psychological Review. 105(2); 325-350.
• Seligman, M.E.P., Walker, E.F. & Rosenhan, D.L. (2001). Abnormal psychology, (4th ed.) New York: W.W. Norton & Company, Inc.
• Zald, D.H., Hagen, M.C. & Pardo, J.V. (2002). "Neural correlates of tasting concentrated quinine and sugar solutions". J. Neurophysiol. 87(2), 1068-75.
• Zald, D.H. & Pardo, J.V. (1997). "Emotion, olfaction, and the human amygdala: amygdala activation during aversive olfactory stimulation." Proc Nat'l Acad Sci USA. 94(8), 4119-24.

External links

• Article: Anxiety Disorders Kathryn J. Zerbe, M.D.
• Article: Treating Anxiety and Depression Kathryn J. Zerbe, M.D.
• eMedicine article on anxiety
• Article: How is anxiety diagnosed? Insight Journal
• Anxiety Attacks Resource
• Common Symptoms of Anxiety Attacks
• Guide to using CBT to treat anxiety
• Biochemical Aspects of Anxiety

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