Anxiety Disorder
Recent epidemiological data indicate that up to 20% of adults are affected by anxiety disorders each year, with prevalence approximately twice as high among women as among men.
Patients with anxiety disorder report symptoms such as continuous fear, unrealistic worry in relation to objective life circumstances, pessimism (typically about finance, family, health, and the future), and a constant feeling of being overwhelmed.
While anxiety is a natural and healthy physiological response to challenging situations, chronic anxiety could reflect pathological vulnerability to stress and, if not treated, increase the risk for cardiocirculatory complications as well as emotional disorders.
Individuals who suffer from anxiety disorder typically find it difficult to control excessive worry, and often report non-specific psychological and physical symptoms.
How do I know I have anxiety disorder?
Anxiety disorder is clinically diagnosed according to the diagnostic criteria in the Diagnostic and Statistical Manual of Mental Disorders, fifth edition (DSM-V). Other tests include: thyroid function tests, blood glucose level, echocardiography, toxicology screen.
Behavioural symptoms include the following:
Excessive anxiety and worry for at least six months
Difficulty controlling the worrying
The anxiety is not attributable to any physical cause
The anxiety is associated with three or more of the below symptoms for at least 6 months:
Restlessness, feeling strained or “on edge”
Dizziness
Chest heaviness
Choking sensation
Changes in heart beat frequency and or blood pressure
Easily triggered fatigue
Reduced ability to focus
Increased and persistent muscle tension
Sleep disturbance
Irritability
Risk factors for anxiety disorder include:
Stress
Exposure to anxiogenic stimuli (e.g., violent visual/auditory stimuli, negative news report, report of sad incidents)
Comorbid emotional disorders such as depression and post-traumatic stress disorder
Family history of generalized anxiety disorder
History of emotional, physical or sexual abuse
Substance abuse
Neurochemical imbalances in anxiety disorder
The exact mechanism is not entirely known. Anxiety can be a normal phenomenon in children. Imbalances in the Noradrenergic, serotonergic, and other neurotransmitter systems are believed to play a role in anxiety disorder.
Evidence suggests that reduced serotonin system activity vs. increased noradrenergic system activity are involved in the generation of symptoms.
Treatment / Management of anxiety disorder
There is no ‘one size fits all’ way of managing anxiety, but there are tried and tested methods which, when applied in the appropriate way, can be very effective therapeutic avenues.
The two main treatments for anxiety disorder are cognitive remediation therapies and pharmacotherapy. In most cases, patients may benefit most from a combination of the two and usually takes some trial and error to establish which treatments are more effective.
Cognitive remediation therapies
Cognitive Behavioral Therapy
Cognitive behavioural therapy (CBT) is psychotherapy aimed at changing thoughts patterns, and gradual exposure to anxiogenic stimuli with the goal of establishing new and effective psychological coping strategies.
Neurofeedback Training
Neurofeedback Training (NFT) is a relatively new, non-invasive method for targeting and treating mental health disorders, and it has been shown to be an effective intervention for anxiety disorders in both children and adults. The aim of NFT is to increase the patient’s ability to control anxiety developing new neural resources in the brain.
Pharmacotherapy
A range of medications are used to treat anxiety disorder:
Antidepressants
Selective serotonin reuptake inhibitors (SSRI, e.g., escitalopram, paroxetine, sertraline and fluoxetine) and serotonin-norepinephrine reuptake inhibitors (SNRI, e.g., duloxetine, venlafaxine).
Antipsychotics
Antipsychotics may also be effective in the treatment of anxiety disorder, especially in patients experiencing psychotic episodes.
Benzodiazepines
Diazepam and Clonazepam can induce immediate short- term reduction of anxiety symptoms. Generally, patients who are more aware that their symptoms have a psychological basis are more likely to respond to benzodiazepines. Importantly, benzodiazepines can induce addiction so they are not recommended for patients with a history of alcoholism or drug abuse.
Buspirone (BuSpar)
Buspirone is a non-benzodiazepine agent which is less likely than benzodiazepines to induce dependency and sedating effects. However, Buspirone typically has an effect lag of two to three weeks which limits its use.
A general rule for all medications
All medications should be titrated slowly and continued for at least 4 weeks to determine their efficacy. Once symptoms are under control, the medications need to be used for at least 12 months before gradually tapering them. Importantly, adverse effects such as weight gain, hyperlipidemia, and diabetes must be considered and patients need to be monitored throughout treatment.
Tips for coping with chronic anxiety
Although the treatments discussed above require guidance from a qualified professional, research has proposed many habits that an individual suffering from chronic anxiety can put into practice to ease anxiety symptoms. Mindfulness, for example, is a type of meditation that teaches how to use negative emotions experienced in the past to cope with the present moment, planning for the future and thinking rationally about possible outcomes.
A healthy diet and an active lifestyle can also greatly contribute to cope with stress and facilitate positive emotions. It can be difficult to implement these life changes, especially when facing fear of change or thoughts of hopelessness. If you are afraid of big changes, keep in mind that incorporating small changes incorporated into a daily routine is a great place to start.
As with all of our interventions, we personalise all our plans on the basis of a formulation by one of our Psychology Team alongside brain data from our Neuroscience Team.
References
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