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Understanding Anxiety
the Basics | Symptoms | Treatment | Prevention
Treatment
How Do I Know if I Have Generalized Anxiety Disorder?
The first step is to rule out the possibility that the symptoms are being caused by a disease. Among the conditions that produce symptoms similar to those of anxiety are hyperthyroidism, too much or too little calcium, low blood sugar and certain heart problems. A thorough evaluation by your doctor will determine if any of these conditions are the cause.
If no organic culprit can be found and the symptoms seem out of proportion to any situation you are facing, the condition will be classified as an anxiety disorder.
What Are the Treatments?
Psychotherapy, with or without medication, is the treatment of choice for generalized anxiety disorder. Exercise and relaxation techniques can help with an anxiety episode, but a person with GAD needs professional help.
Psychotherapy helps a person deal with thoughts and feelings that lie at the roots of anxiety. A therapist helps a person experience these thoughts and emotions within the safe confines of the therapeutic relationship.
Cognitive-behavioral therapy has the twin goals of changing a person's ways of thinking and acting in order to avoid anxiety and to deal with it more effectively. Both types of therapy can be very effective for GAD.
Daily exercise can be one of the most potent treatments for anxiety symptoms. If you find that exercise works for you, push yourself to go for brisk walks or undertake an active sport that you enjoy. Get your heart rate into the target range for your age for at least 30 minutes.
Medication is useful for alleviating the symptoms of anxiety and is often prescribed in conjunction with other therapies. Most of these drugs can be addictive; usually they are prescribed for short-term or as-needed use. The most prominent of anti-anxiety drugs are those known as benzodiazepines; among them are lorazepam, diazepam, alprazolam and clonazepam. They have drawbacks: Benzodiazepines sometimes cause drowsiness, irritability, dizziness, and dependency. Nonetheless, in recent
decades they have largely replaced barbiturates because of the threat of intentional overdose by suicidal patients. Another anti-anxiety drug is buspirone. It has fewer side effects than the benzodiazepines and is not associated with dependence. Buspirone has its own side effects and may not always be as effective when a person has taken benzodiazepines in the past.
Antidepressants, particularly the selective serotonin reuptake inhibitors (SSRIs), are now also widely used for a variety of anxiety disorders and can be as helpful in managing long-term anxiety problems. Examples of SSRIs that are sometimes used to treat chronic anxiety include Prozac, Zoloft and Paxil, and more recently, Lexapro. One problem with SSRIs is that the long-term effects of daily use remain unknown. The antidepressants Effexor and Cymbalta, a newer antidepressant, and some of the tricyclic antidepressant imipramine may also help. Finally, antihistamines (such as hydroxyzine) and beta-blockers (such as Inderal) can help mild cases of anxiety as well as performance anxiety called social anxiety disorder (SAD).
Since anxiety is almost always accompanied by shallow breathing, deep breathing exercises are very helpful. Try the following form of yoga breathing: Lie on your back in a comfortable place. Breathe in slowly through your nose, using your diaphragm to suck air into your lungs while allowing your abdomen to expand. (Put your hand on your abdomen just below the navel to make sure the abdomen is being pushed up and out by the diaphragm.) After the abdomen is expanded, continue to inhale as deeply as possible. When you breathe out, reverse the process: Contract the abdomen while exhaling slowly and completely. Repeat several times.
Biofeedback is another helpful tool. In a series of sessions with a therapist, the patient watches his or her own brain-wave patterns on an electroencephalograph and gradually learns to control the waves. This teaches a person to achieve a more relaxed state at will. Practitioners estimate that after about a dozen sessions, the patient will be able to exert control over mental activity without the help of the therapist or monitoring instrument.
Progressive relaxation is another helpful technique. It begins by tensing and then relaxing one part of the body, usually beginning with the toes. When this part of the body is relaxed, another part of the body is tensed and relaxed until the entire body is free of tension.
Relaxing visualization can also help. A therapist or meditation trainer suggests relaxing images for a person to hold in mind. Once the image is in place, the person imagines soothing sensations such as pleasant scents and sounds. Eventually people can learn to do this themselves when they anticipate -- or find themselves in -- stressful situations.
the Basics | Symptoms | Treatment | Prevention
