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Anxiety
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OVERCOMING ANXIETY
Introduction
Stress and anxiety have been with us since the beginning of mankind and
with the increase in pressure from modern society, more and more people
are suffering either the psychological or physical aspects of stress.
Approximately 1 in 10 of the population suffers from anxiety states and
a large number of this group will suffer from phobias (irrational fears)
as well.
Burn-out syndromes are very common in the work situation, where the
person feels apathetic and disinterested in their job and virtually becomes
phobic about attending the work place. It is important to achieve a balance
between too much and too little stress in our lives and people in high
stress jobs, are just as vulnerable as people who are under-performing
and are bored with their routine existence.
Causes
Some degree of stress is important in our everyday lives to help to motivate
us and we cannot live without this. Man is an animal, and as animals,
we respond to stress with the “flight or fight” syndrome.
This produces adrenalin so that we can flee or fight our aggressors. However,
in modern society, we are unable to do this, so that the adrenalin gets
turned on ourselves, producing anxiety symptoms. Obviously some of us
have long-standing anxious personalities which can be traced back to early
childhood and this group of people are more prone to developing anxiety
states than the general population. However, everybody can develop anxiety
if they are placed under sufficient stress. Certain life events
have been shown very clearly to relate to our performance and anxiety
symptoms. Any change in our lives can be anxiety provoking.
Grief is a common cause for anxiety where there is loss either
through bereavement, divorce, loss of job, loss of financial status, change
of house or our children leaving home. All of these life events produce
a change in our life pattern and depending on the flexibility of our personality,
we cope with them in different ways. Many people use chemicals to cope
with their stress and these include:- caffeine, alcohol, nicotine, illegal
drugs as well as legally prescribed drugs such as tranquillisers.
Symptoms of Stress
Symptoms of stress can be divided into psychological and physical
symptoms. Psychological symptoms are as follows:- apprehension, feelings
of anxiety and depression, irritability, hostility, marked feelings of
frustration, disturbed sleep pattern, agitation, talking too quickly and
loudly.
Physical symptoms of anxiety include:- tension headaches, cervical
tension, dizziness, rapid heart beat, palpitations, shortness of breath,
choking sensations, hyperventilation where we have short, shallow breathing,
churning in the stomach, nausea, vomiting, nervous diarrhoea, frequency
of passing urine, weakness at the knees, hand tremor, sweating, pins and
needles sensations, and often, in a panic attack a feeling that we are
going to collapse and die.
Most people with anxiety states become rather concerned about their physical
health and feel that they are seriously physically ill. However, the mind
is a powerful organ in its own right and it produces these psychosomatic
symptoms. Hence, when we are under severe stress, we are more prone to
develop phobias, which may start when we have an acute panic attack in
a specific situation, such as a supermarket, crowded shops, buses, trains,
the underground and lifts.
Agoraphobia, which is a fear of open spaces, is extremely common
in women and this prevents them from leading normal lives, because they
use the avoidance response frequently to cope with their panic attacks.
In other words, they avoid going into situations which make them feel
anxious and this increasingly limits their lifestyle.
Social phobia is more common in men and in these situations, the man is
frightened of public speaking, authority figures and social situations
in the work place. Most of these phobias are common, but people can develop
a phobia to virtually anything.
Treatment
The person who is suffering severe anxiety is out of control regarding
their life and needs to regain control as rapidly as possible. There is
often a temptation to blame external factors when this happens and the
problem often lies within ourselves. The first stage of recovery, is to
be able to stand back from the problem and give ourselves “space”
to see the problem more clearly. The actual process of change requires
determination, motivation and considerable courage. However, change can
be very painful and it is important to face up to difficult habits of
a life time. It is necessary to realise that no human being is perfect
and that we all have problems and difficulties in our life pattern. It
is also important to be assertive about oneself, which often means writing
lists of positive and specific factors which you are proud of in your
life. To be able to talk to somebody close about your difficulties is
very helpful and if this is not available, then your own family doctor
or a priest maybe able to help you. You could also arrange to see counsellors
or psychotherapists, as well as voluntary organisations in the community
which can provide counselling services.
If work is the major cause of stress, it is important to organise your
work routine and maintain efficiency and enjoyment in the work situation.
It is also valuable to allow sufficient time to complete the task and
to learn to say “no” when you are asked to do too many
things at once and this takes in the need to delegate work to other people.
Balancing your time is necessary between work, family social life and
hobbies and leisure pursuits.
Exercise is also important for “burning off’ the excess
adrenalin and helping to relieve the anxiety symptoms.
More specific relaxation techniques include relaxation therapy, yoga,
transcendental meditation, hypnosis, and massage. Many Adult Education
classes carry out these programmes, or there are practitioners in the
community, or more specific relaxation techniques at local psychiatric
units. If the person has a specific phobia, then a combination of relaxation
and also behaviour therapy is very effective.
Behaviour therapy is a way of modifying the response to the phobia
and is often carried out in a slow “step-ladder” approach
to gradually reverse the phobia. The person has to pursue increasingly
more difficult tasks, whilst using relaxation therapy, to help to cope
with their anxiety symptoms. Most psychiatrists would be able to provide
this type of treatment and failing that, clinical psychologist would certainly
be able to help to decondition the phobia with a behavioural programme.
Psychotherapy is also very effective for those people who have
unconscious conflicts which can be traced back to early childhood, which
are producing marked anxiety symptoms at present. Psychotherapy is a process
of talking about these fears and difficulties and it is certainly beneficial
for a certain group of people.
A large number of patients receive drug treatment for their phobias and
also anxiety states. These fall into three broad groups. Minor tranquillisers
or benzodiazepines are very useful for relieving anxiety, but should only
be given for a short course of no more than 4 to 6 weeks. There has been
considerable discussion about the risk of addiction with this medication
and whilst these drugs are effective and safe, if anxiety symptoms continue,
then it is important to try and find the cause of the symptoms and remove
them with other treatment programmes. Beta-blocker drugs are also helpful
for relieving psychosomatic symptoms of anxiety, as they block adrenalin
which causes these symptoms and these drugs are not addictive. A large
number of patients find anti-depressants useful as well and there is no
risk of addiction with this medication. For a certain group of people
who lack assertion or self-esteem, assertion training, self-esteem enhancement,
and social skills training,are also effective techniques to help them
to relieve these problems. Obviously, it is difficult to explain in any
great detail about the treatments that are available for anxiety states
and phobias in a relatively short leaflet. People with these types of
problems should initially go and see their family doctor who would be
able to advise them accordingly and may, in certain cases, refer them
to a consultant psychiatrist, a clinical psychologist or a counsellor
for further assessment.
Dr Adrian Winbow MB. BS. MRCPsych. DPM
Submenu : Overcoming Anxiety
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