Anxiety

How to manage anxiety?

Dr. Girish Banwari, Specialist Psychiatrist

Dr. Girish Banwari is a psychiatrist at Camali Clinic with over 10 years’ clinical experience in both government and private settings in specialised psychiatry clinics as well as tertiary care, multi-speciality hospitals. He has worked as Assistant Professor of Psychiatry at reputed medical colleges in India and was extensively involved in teaching undergraduate medical students along with being a faculty member of the postgraduate psychiatry training program. He has a special interest in Psychopharmacology and can treat patients of all ages with a focus on adults and the elderly.

Anxiety is the body’s natural response to stress. It is most often characterized by a diffuse, unpleasant, vague sense of apprehension, commonly accompanied by physical symptoms such as increased heart rate, rapid breathing, restlessness, sweating, trembling, butterflies in the stomach, losing control etc.

It is quite normal and natural to feel anxious about moving to a new place, taking a test, making an important decision, or facing a challenging situation. This type of anxiety is unpleasant, but it can help a person to stay alert and focused, spur one to action, and motivate one to solve problems. Ordinary anxiety is a feeling that comes and goes but does not significantly interfere with one’s everyday life.

When anxiety becomes intense, excessive, persistent or overwhelming, one might have likely crossed the threshold from normal anxiety into the zone of an anxiety disorder. The symptoms can interfere with daily activities such as job performance, schoolwork, and maintaining relationships.

Signs and symptoms of anxiety disorders

Generalised anxiety disorder (GAD)

People with GAD display excessive anxiety or worry, about several things such as health, work, social interactions, and everyday routine life circumstances, or activities, usually accompanied by the following symptoms –

  • Feeling restless, or on-edge
  • Being easily fatigued
  • Having difficulty concentrating; mind going blank
  • Being irritable
  • Having muscle tension
  • Difficulty controlling feelings of worry
  • Sleep problems

Panic Disorder

Panic attacks are periods of intense fear that come on abruptly, reach their peak and subside quickly, usually within minutes. Attacks can be triggered by a feared object or situation, or they sometimes seem to happen for no apparent reason, completely “out of the blue.” When a person has unexpected panic attacks repeatedly, it is termed panic disorder.

During a panic attack, people may experience some of the following symptoms –

  • Palpitations, pounding heart, or an accelerated heart rate
  • Sweating
  • Trembling or shaking
  • Sensations of shortness of breath, or smothering,
  • Feelings of choking
  • Chest pain or discomfort
  • Nausea or abdominal distress
  • Feeling dizzy, unsteady, light-headed, or faint
  • Chills or hot sensations
  • Numbness or tingling sensations
  • Fear of losing control or going crazy
  • Fear of dying

Specific phobia

The term phobia refers to excessive and intense fear of a specific object, circumstance, or situation. People with a phobia have the following symptoms –

  • Marked anxiety about encountering a specific object or situation (e.g., flying, driving, animals, heights, receiving an injection, seeing blood, etc.)
  • The phobic object or situation is actively avoided or endured with intense fear or anxiety

Social phobia

People with social phobia have an intense fear of, or anxiety toward, social or performance situations. They worry that their actions or behaviours will be negatively evaluated by others, leading them to feel embarrassed. This worry often causes them to avoid social situations.

Causes of anxiety

Genetic, neurochemical and environmental factors can contribute to the risk of developing an anxiety disorder. Known risk factors are as follows –

  • Having first- or second-degree relatives with an anxiety disorder
  • Being exposed to stressful and negative life events in early childhood
  • Stressful life situations, e.g., death of a loved one, work stress, relationship distress, worry about finances etc.
  • People with certain personality types are more prone to anxiety than others
  • Other mental health conditions, such as depression, increase susceptibility to having an anxiety disorder
  • Drug or alcohol use or withdrawal can cause or worsen anxiety
  • Certain medical conditions, such as thyroid problems, anaemia or heart arrhythmias

Management of anxiety

Psychotherapy

This is a type of counselling, wherein a mental health specialist helps the person by talking about how to understand and deal with the symptoms of anxiety.

Cognitive behavioural therapy (CBT) - This is a type of psychotherapy that teaches how to recognize and change thought patterns and behaviours that trigger and maintain anxiety, hence resulting in symptom reduction or resolution.

Medication management

Antidepressant medications, such as selective serotonin reuptake inhibitors (SSRIs) are commonly used as first-line treatments for anxiety, they have known and proven efficacy in treating anxiety disorders.

Other medications such as benzodiazepines are indicated for short term use to reduce acute symptoms of anxiety, they are quite potent and effective, but carry dependence and abuse potential, if used for long term.

Other practices that might reduce anxiety include –

  • Deep relaxation techniques, such as progressive muscle relaxation
  • Deep breathing exercises, such as abdominal breathing
  • Meditation and mindfulness exercises
  • Cutting down on foods and drinks that have caffeine, such as coffee, tea, cola, energy drinks, and chocolate
  • Lifestyle changes such as eating right, being physically active, and getting better sleep
  • Brisk aerobic exercises like jogging and biking help release brain chemicals that cut stress and improve mood
  • Limiting nicotine, alcohol, and other substances of abuse
  • Taking time out, listening to music, pursuing hobbies
  • Accepting that one cannot control everything
  • Writing in a journal when one is feeling stressed or anxious, and looking for a pattern of what triggers the anxiety
  • Getting involved, volunteering or finding another way to be active in one’s community helps creates a support network and gives one a break from everyday stress, hence reducing anxiety

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