Anxiety

(Generalized anxiety, hyperventilation, panic attacks)

Anxiety, often referred to as excessive nervousness, is a pervasive sense of apprehension. Sometimes the feeling is prompted by worry over an impending event, such as a school examination or medical test. This type of anxiety is a normal response to a specific circumstance. In contrast, generalized anxiety produces feelings of foreboding that stem from almost any uncertainty or even no apparent provocation. When carried to extremes, this type of anxiety leads to emotional exhaustion, sleeplessness, and an increased risk of stress-related illnesses.

Acute anxiety sometimes takes the form of a panic attack. This is an episode of intense fear accompanied by physical symptoms, such as chest pain, difficulty breathing, and a feeling of impending doom. Recent studies have indicated that panic attacks are likely to run in families, and they may begin in early adolescence.

Hyperventilation, or over-breathing, is common during a panic attack, and this rapid, shallow breathing upsets the balance of oxygen and carbon dioxide in the blood. This in turn leads to dizziness, palpitations, chest pain, and other unpleasant physical symptoms that are so distressing, they themselves engender fear and anxiety, resulting in a vicious cycle of increasingly frequent panic attacks. People with anxiety go to great lengths to avoid what they think are triggers. Many even fear venturing from the safety of their homes, a condition called agoraphobia.

Diagnostic Studies and Procedures

Some people who experience chronic anxiety fail to relate their physical symptoms to their emotional apprehensions. These people may go from doctor to doctor trying to find causes for troubling symptoms -- back pain, frequent headaches, muscle and joint aches, indigestion, and diarrhea. Typically, a physical examination and medical tests fail to find an organic cause for all the problems. At this point, a physician may suspect anxiety as the underlying cause and suggest that the patient consult a psychiatrist or other mental health professional for diagnosis and treatment.

Panic attacks are easier to diagnose than generalized anxiety. Typically, they are sudden and unprovoked and last for only 5 to 10 minutes, although they may seem much longer to the sufferer. According to the diagnostic guidelines of the American Psychiatric Association, a panic attack is characterized by the presence of at least four of the following signs and symptoms:

• Shortness of breath.
• Dizziness, unsteadiness, or faintness.
• Palpitations.
• Trembling and shaking.
• Profuse sweating.
• Chest pains or discomfort.
• Nausea and abdominal distress.
• Gagging or a choking sensation.
• Hot and cold flashes.
• Numbness or tingling sensations in the hands or feet.
• Dizziness or vertigo.
• Fear of losing control.
• Intense fear of dying.

Medical Treatments

The two approaches to treatment, medication and psychological counseling, are often combined.

Drug Therapy. Anti-anxiety drugs, or tranquilizers, are the major medical treatments for both generalized anxiety and panic attacks. A class of drugs, known as benzodiazepines and marketed as Librium, Valium, Ativan, and Xanax, are the most widely prescribed antianxiety medications. These drugs appear to work by increasing the action of a brain chemical that blocks the transmission of nerve impulses in the brain, thus reducing the feelings of jittery nerves and restlessness. In the process, they can cause drowsiness and lethargy. They also heighten the effects of alcohol, sometimes dangerously so, a because the combination can lead to respiratory arrest and death.

After three months of benzodiazepine treatment, 90 percent of panic-attack patients show marked improvement and 50 percent are entirely free of them.

Although tranquilizers are highly effective in easing anxiety and overcoming panic attacks, they should not be used for an extended period of time -- usually defined as more than 129 consecutive weeks -- because continued use can lead to psychological dependence and addiction. However, anyone who has been taking tranquilizers regularly for several months should not stop them abruptly. Instead a doctor's guidance should be sought for gradually dispensing with them.

Less addictive drugs are sometimes a prescribed instead of tranquilizers. Among them, beta blockers -- normally used to treat high blood pressure and angina -- are effective against specific kinds of anxiety, especially stage fright. These medications ease feelings of anxiety by blocking the action of norepinephrine, or noradrenaline, a neurotransmitter that the body produces in response to stress.

In the past, meprobamaie (Equanii or Miltown), a tranquilizer, and phenobarbital, a barbiturate, were used to treat anxiety. They are rarely prescribed for this purpose today because of their addictiveness and potential for abuse.

Psychotherapy. Psychiatrists and other mental health professionals usually recommend some form of psychotherapy in addition to tranquilizers. Treatment may range from long-term one-on-one psychotherapy to short-term cognitive therapy. During the latter, patients are helped to correct distorted ways of thinking about themselves and their fears. Through cognitive therapy, for example, a person can control panic attacks by learning to interpret and calmly handle the alarming symptoms rather than overreacting to them, which usually intensifies the problem.

Another approach is to enter group therapy, in which patients share common fears and seek workable ways of dealing with them.

Alternative Therapies

Alternative therapies that emphasize relaxation techniques are often incorporated into conventional medical treatment for anxiety and panic attacks. The breathing exercises of relaxation methods are especially helpful in preventing or stopping hyperventilation. Specific therapies may include:

Biofeedback. Patients learn how to control overbreathing and other physical responses that trigger or worsen panic attacks. Certain techniques can then be applied in situations that are likely to provoke an episode.

Herbal Medicine. Caffeine-free herbal teas can help calm jittery nerves. In addition, some herbs contain chemicals that can offset the common effects of anxiety. For example, betony can lower blood pressure, and lemon balm, mint, and valerian can counter insomnia.

Hypnosis and Visualization. These are especially useful in controlling panic attacks. During a few sessions with a hypnotist, a person can learn to quell anxious feelings by combining deep breathing exercises with meditation or visualization of a particular setting or situation. Methods of self-hypnosis can also be learned by using an audio tape or home course.

Massage. Few activities are more conducive to releasing stress than a massage, either from a professional therapist or someone close to you The use of aromatic oils or lotions makes this therapy even more relaxing.

Music Therapy. Listening to music is a time-honored method of relaxation. To alleviate anxiety, music therapists recommend soothing classical music rather than loud, percussive types. Music associated with a happy event or time period can also be beneficial.

Yoga and T'ai Chi. These movement therapies are directed to achieving emotional well-being by balancing mental and physical energies. Yoga is especially helpful in developing the ability to breathe deeply and slowly and thus avoid hyperventilation. Consult a professional instructor to learn specific postures or techniques that are particularly suited to overcoming anxiety.

Self-Treatment
Setting aside at least 30 minutes each day for quiet, private time does wonders in dissipating anxiety. Try using this time to meditate, do yoga or t'ai chi, or listen to music. Or simply clear your mind of pressing obligations by reading, exercising, or engaging in some other pleasurable activity. Additional self-help measures include:

Breathing Exercises. Hyperventilation can be controlled by breathing into and out of a paper or plastic bag. This forces you to reinhale some of the carbon dioxide that is exhaled during rapid, shallow breathing. At other times, practice slow, deep breathing, inhaling through your nose and slowly exhaling through your mouth.

Exercise. Daily aerobic exercise contributes to both physical and emotional health. Choose a noncompetitive activity such as swimming, biking, or walking.

Stimulants. Overuse of caffeine, nicotine, and other stimulants contributes to feelings of anxiety. Switch to decaffeinated beverages and, if you smoke, make every effort to stop.

Diet. Some people find that certain foods promote feelings of anxiety. This may be an allergic reaction or an exaggerated response to a food additive. Keep a food diary, and try to eliminate items that provoke symptoms.

Other Causes of Anxiety

Alcohol abuse, excessive caffeine, or the use of diet pills, steroids, and certain other medications can produce feelings of anxiety. For many women, anxiety is part of the premenstrual syndrome. An overactive thyroid gland can also provoke jitteriness.