Everybody has it. It is a natural part of life. Fortunately for most of us it isn t intense and persistent. It is anxiety. When speaking in front of a class, when peering down from a ledge, when waiting to play in the big game, anyone of us might feel anxious. But when this occasional uneasiness becomes overwhelming and an everyday occurrence, one might be diagnosed with an anxiety disorder.
Anxiety disorders are psychological disorders characterized by distressing, persistent anxiety or maladaptive behaviors that reduce anxiety. According to David Myers there are five different types of anxiety disorders. They are Generalized Anxiety Disorder (GAD), Phobias, Post-Traumatic Stress Disorder, Obsessive Compulsive Disorder (OCD), and Panic Disorders. Accurate diagnosis is important, since treatment varies from one disorder to another.
Depending on the disorder, behavior therapy, drugs, or psychotherapy, alone or in appropriate combinations, can significantly relieve the distress and dysfunction for most people. The Surgeon General declares that the medications typically used to treat patients with anxiety disorders are benzodiazepines, antidepressants, and buspirone. The benzodiazepines are a large class of relatively safe and widely prescribed medications that have rapid and profound antianxiety and sedative-hypnotic effects. The four benzodiazepines currently widely prescribed for treatment of anxiety disorders are diazepam, lorazepam, clonazepam, and alprazolam. Benzodiazepines have the potential for producing drug dependence or behavioral symptoms after discontinuation of use.
Most antidepressant medications have substantial antianxiety and anti panic effects in addition to their antidepressant action. Fluoxetine, sertraline, paroxetine, fluvoxamine, and citalopram hav emerged as the preferred types of antidepressants for treatment of anxiety disorders. When effective in treating anxiety, antidepressants should be maintained for at least four to six months, then tapered slowly to avoid discontinuation-emergent activation of anxiety symptoms. Unlike the benzodiazepines, buspirone is not habit forming and has no abuse potential. Buspirone takes four to six weeks to exert therapeutic effects, like antidepressants, and has little value for patients when taken on an as needed basis. Harold Bernard, author of Psychology of Learning and Teaching, states that anxiety disorders are responsive to counseling and to a wide variety of psychotherapies.
The hallmarks of cognitive-behavioral therapies are evaluating apparent cause and effect relationships between thoughts, feelings, and behaviors, as wells as implementing relatively straightforward strategies to lessen symptoms and reduce avoidance behavior. A critical element of therapy is to increase exposure to the stimuli or situations that provoke anxiety. Without such therapeutic assistance, the sufferer typically withdraws from anxiety-inducing situations, inadvertently reinforcing avoid ant or escape behavior. The therapist provides reassurance that the feared situation is not deadly and introduces a plan to enhance mastery. This plan may include approaching the feared situation in a graduated or stepwise hierarchy or teaching the patient to use responses that dampen anxiety, such as deep muscle relaxation or coping one fundamental principle is that prolonged exposure to a feared stimulus reliably decreases cognitive and physiologic symptoms of anxiety. Generalized Anxiety Disorder (GAD) is characterized by six months or more of chronic, exaggerated worry and tension that is unfounded or much more severe than the normal anxiety most people experience.
People with this disorder usually expect the worst; they worry excessively about money, health, family, or work, even when there are no signs of trouble. They are unable to relax and often suffer from insomnia. Many people with GAD also have physical symptoms, such as fatigue, trembling, muscle tension, headaches, irritability, or hot flashes. About three to five percent of adults have it at some time during a given year. Statistics from the National Institute of Mental Health report that women are twice as likely as men to have GAD. It often begins in childhood or adolescence but may start at any age.
For most people, the condition fluctuates, worsening at times, and persists over many years. Medication is the primary treatment for GAD. Benzodiazepines are usually prescribed, but buspirone is another effective drug for treating GAD. Behavior therapy isn t usually beneficial because no clear-cut situations trigger the anxiety. Relaxation and biofeedback techniques may be of some help. For some people psychotherapy may be effective in helping to understand and resolve internal psychological conflicts.
Phobias involve persistent, unrealistic, intense anxiety in response to specific external situations, such as looking down from heights, or coming near a small dog. People who have a phobia avoid situations that rigger their anxiety, or they endure them with great distress. However, they recognize that their anxiety is excessive and therefore are aware that they have a problem. Two of the most common phobias are agoraphobia and social phobia. Agoraphobia literally means fear of the marketplace or open spaces, the term more specifically describes the fear of being trapped without a graceful and easy way to leave if anxiety should strike. Certain situations that cause anxiety for people with agoraphobia are standing in line, sitting in the middle of a row at the theater or in a classroom, and riding on a bus or airplane.
Agoraphobia often interferes with daily living, sometimes so drastically that it leaves the person housebound. Social phobia is the fear of being humiliated in a social setting, such as when meeting new people, giving a speech, or talking to the boss. For people with social phobia the fear is not mild or moderate and never passes, The fear is extremely intrusive and can disrupt normal life. The best treatment for agoraphobia is exposure therapy, a type of behavior therapy. With the help of a therapist, the person seeks out, confronts, and remains in contact with what he / she fears until their anxiety is slowly relieved by familiarity with the situation.
People with agoraphobia who are deeply depressed may need to take an antidepressant. Social phobia can be effectively treated with medications including benzodiazepines. Franklin R. Schneier informs us in his book, Detachment and Generalized Social Phobia, that exposure therapy may also be a very useful treatment of social phobia. Post-Traumatic Stress Disorder is an extremely debilitating condition that can occur after exposure to a terrifying event or ordeal in which grave physical harm was threatened or occurred. These traumatic events may include rape or mugging, natural or manmade disasters, car accidents, or military combat.
Most people try to avoid any reminder or thoughts of the ordeal but constantly re-experience the event in the form of flashback episodes, memories, nightmares, or frightening thoughts. Post-Traumatic Stress Disorder is only diagnosed if the symptoms last more than one month. Treatment involves behavior therapy, drugs, and psychotherapy. In behavior therapy, the person is exposed to situation that may trigger memories of the painful experience. After some initial increase in discomfort, behavior therapy usually lessens a person s distress. Antidepressant and antianxiety drugs appear to provide some benefit.
Because of the often intense anxiety associated with traumatic memories, supportive psychotherapy plays an especially important role. Psychotherapeutic techniques may be needed to help the person retrieve key traumatic memories that had been repressed, so that the memories can be dealt with constructively. Obsessive-Compulsive Disorder is characterized by the presence of recurrent, unwanted, intrusive ideas, images, or impulses that seem silly, weird, nasty, or horrible (obsessions) and an urge or compulsion to do something that will relieve the discomfort cause by an obsession. Common obsessions include concerns about contamination, doubt, loss, and aggressiveness.
Rituals such as handwashing, counting, checking, or cleaning are often performed in hope of preventing obsessive thoughts or making them go away. Most people with Obsessive-Compulsive Disorder are aware that the obsession don t reflect actual risks. They realize that their physical and mental behavior is excessive to the point of being bizarre. Exposure therapy often helps with this disorder, teaching the person that the ritual isn t needed to decrease discomfort. Five drugs have been effective in treating Obsessive-Compulsive Disorder, these include clomipramine, fluoxetine, fluvoxamine, paroxetine, and sertraline. Certain other antidepressant drugs are also used, but much less often.
Psychotherapy has generally not been effective for people with Obsessive-Compulsive Disorder. Panic disorder is characterized by unexpected and repeated episodes of intense fear accompanied by physical symptoms that may include chest pain, heart palpitations, shortness of breath, dizziness, or abdominal distress. The diagnosis of a panic disorder is frequently not made until extensive and costly medical procedures fail to provide a correct diagnosis or relief. Part of this disorder is the appearance of panic attacks that are often unexpected and occur for no apparent reason.
A panic attack involves the sudden appearance of at least four of the following symptoms: shortness of breath or sense of being smothered; dizziness; unsteadiness, or faintness; palpitation or accelerated heart rate; trembling or shaking; sweating; choking; nausea, stomachache, or diarrhea; feelings of unreality, strangeness, or detachment from environment; numbness or tingling sensations; flushing or chills; chest pain or discomfort; fear of dying; and fear of going crazy or losing control. Drugs that are used to treat panic disorder include antidepressants and antianxiety drugs such as benzodiazepines. When a drug is effective, it prevents or greatly reduces the number of panic attacks. Exposure therapy, where the person is exposed repeatedly to whatever triggers the panic attack, often helps to diminish fear. Psychotherapy may also be useful.
Accurate diagnosis is important, since treatment varies from one disorder to another. A family history of an anxiety disorder may help the doctor make the diagnosis, since the predisposition to a specific anxiety disorder as well as a susceptibility to anxiety disorders in general often is hereditary. Works Cited Bernard, Harold W. Psychology of Learning and Teaching. New York: McGraw-Hill Book Company, 1965. Cain, Dr.
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