ANXIETYHongbiao (Hank) Liu MD PhDLuna Medical Care PC
Overview• What is Anxiety?• What are the different types of anxiety disorders?• What are the causes?• What are the symptoms?• What are the treatments?• Professional Resources available.
Definition of Anxiety• Anxiety is a feeling of apprehension or fear. The source of this uneasiness is not always known or recognized, which can add to the distress you feel.• Anxiety disorders are a group of psychiatric conditions that involve excessive anxiety.
Anxiety Facts• Most common mental illness in the U.S. with 19 million of the adult (ages 18-54) U.S. population affected.• Anxiety disorders cost more than $42 billion a year.• More than $22 billion are associated with the repeated use of healthcare services, as those with anxiety disorders seek relief for symptoms that mimic physical illnesses.• Anxiety is highly treatable (up to 90% of cases), but only one-third of those who suffer from it receive treatment• People with an anxiety disorder are three-to-five times more likely to go to the doctor and six times more likely to be hospitalized for psychiatric disorders than non-sufferers.• Depression often accompanies anxiety disorders 2003 Anxiety Disorders Association of America
Panic Disorder • The abrupt onset of an episode of intense fear or discomfort, which peaks in approximately 10 minutes, and includes at least four of the following symptoms:• A feeling of imminent danger or doom • Nausea or abdominal discomfort• The need to escape • Dizziness or lightheadedness• Palpitations • A sense of things being unreal,• Sweating depersonalization• Trembling • A fear of losing control or "going crazy"• Shortness of breath or a smothering • A fear of dying feeling • Tingling sensations• A feeling of choking • Chills or hot flushes• Chest pain or discomfort
Panic DisorderThere are three types of Panic Attacks: 1. Unexpected - the attack "comes out of the blue" without warning and for no discernable reason. 2. Situational - situations in which an individual always has an attack, for example, upon entering a tunnel. 3. Situationally Predisposed - situations in which an individual is likely to have a Panic Attack, but does not always have one. An example of this would be an individual who sometimes has attacks while driving.
Obsessive-CompulsiveDisorderCharacterized by uncontrollable obsessions and compulsions which the sufferer usually recognizes as being excessive or unreasonable.• Obsessions are recurring thoughts or impulses that are intrusive or inappropriate and cause the sufferer anxiety: – Thoughts about contamination, for example, when an individual fears coming into contact with dirt, germs or "unclean" objects; – Persistent doubts, for example, whether or not one has turned off the iron or stove, locked the door or turned on the answering machine; – Extreme need for orderliness; – Aggressive impulses or thoughts, for example, being overcome with the urge to yell fire in a crowded theater
Obsessive-CompulsiveDisorder• Compulsions are repetitive behaviors or rituals performed by the OCD sufferer, performance of these rituals neutralize the anxiety caused by obsessive thoughts, relief is only temporary. – Cleaning. Repeatedly washing their hands, showering, or constantly cleaning their home; – Checking. Individuals may check several or even hundreds of times to make sure that stoves are turned off and doors are locked; – Repeating. Some repeat a name, phrase or action over and over; – Slowness. Some individuals may take an excessively slow and methodical approach to daily activities, they may spend hours organizing and arranging objects; – Hoarding. Hoarders are unable to throw away useless items, such as old newspapers, junk mail, even broken appliances• In order for OCD to be diagnosed, the obsessions and/or compulsions must take up a considerable amount of the sufferers time, at least one hour every day, and interfere with normal routines .
Post-Traumatic StressDisorder• Exposure to traumas such as a serious accident, a natural disaster, or criminal assault can result in PTSD. When the aftermath of a traumatic experience interferes with normal functioning, the person may be suffering from PTSD.• Symptoms of PTSD are: – Reexperiencing the event, which can take the form of intrusive thoughts and recollections, or recurrent dreams; – Avoidance behavior in which the sufferer avoids activities, situations, people,and/or conversations which he/she associates with the trauma; – A general numbness and loss of interest in surroundings; – Hypersensitivity, including: inability to sleep, anxious feelings, overactive startle response, hypervigilance, irritability and outbursts of anger.
Social Phobia/Anxiety• Social anxiety disorder, also known as social phobia, is an intense fear of social situations. This fear arises when the individual believes that they may be judged, scrutinized or humiliated by others.• Individuals with the disorder are acutely aware of the physical signs of their anxiety and fear that others will notice, judge them, and think poorly of them.• In extreme cases this intense uneasiness can progress into a full blown panic attack.
Social Phobia/Anxiety• Common anxiety provoking social situations include: – public speaking – talking with people in authority – dating and developing close relationships – making a phone call or answering the phone – interviewing – attending and participating in class – speaking with strangers – meeting new people – eating, drinking, or writing in public – using public bathrooms – driving – shopping
Generalized AnxietyDisorder• Excessive uncontrollable worry about everyday things. This constant worry affects daily functioning and can cause physical symptoms.• GAD can occur with other anxiety disorders, depressive disorders, or substance abuse.
Generalized AnxietyDisorder• The focus of GAD worry can shift, usually focusing on issues like job, finances, health of both self and family; but it can also include more mundane issues such as, chores, car repairs and being late for appointments.• The intensity, duration and frequency of the worry are disproportionate to the issue
Specific Disorder Facts• Generalized Anxiety Disorder – Women are twice as likely to be afflicted than men. – Very likely to exist along with other disorders.• Obsessive Compulsive Disorder – It is equally common among men and women. – One third of afflicted adults had their first symptoms in childhood.• Panic Disorder – Women are twice as likely to be afflicted than men. – Occurs with major depression in very high rates. 2003 Anxiety Disorders Association of America
Specific Disorder Facts• Posttraumatic Stress Disorder – Women are more likely to be afflicted than men. – Rape is the most likely trigger of PTSD, 65% of men and 45.9% of women who are raped will develop the disorder. – Childhood sexual abuse is a strong predictor of lifetime likelihood for developing PTSD.• Social Anxiety Disorder – It is equally common among men and women.• Specific Phobia affects – Women are twice as likely to be afflicted as men 2003 Anxiety Disorders Association of America
Anxiety Statistics Anxiety Disorders One-Year Prevalence (Adults) Percent Population Estimate* (Millions) Any Anxiety Disorder 13.3 19.1 Panic Disorder 1.7 2.4 Obsessive-Compulsive 2.3 3.3 Disorder Post-Traumatic Stress 3.6 5.2 Disorder Any Phobia 8.0 11.5 Generalized Anxiety 2.8 4.0 Disorder * Based on 7/1/98 U.S. Census resident population estimate of 143.3 million, age 18-54
Recent StudiesFreedom From Fear conducted a survey among 410 attendees duringNational Anxiety Disorders Screening Day on May 7, 2003. The results : •An increase in physical aches and pains is directly attributed to anxiety disorders and depression •60%) of the respondents with undiagnosed medical conditions said that on days when they feel anxious or depressed, there is a moderate (41%) to severe (19%) change in their physical symptoms or aches and pains. These physical symptoms or aches and pains include backaches (13%), vague aches and pains (14%), headaches (14%), digestive pain (11%) and dizziness (8%). •50% of respondents with diagnosed medical conditions, such as arthritis, migraines, diabetes, heart and respiratory diseases, reported that on days when they feel anxious or depressed, there is a moderate (38%) to severe (12%) change in their physical symptoms or aches and pains.
Common Causes• There is no one cause for anxiety disorders. Several factors can play a role – Genetics – Brain biochemistry – Overactive "fight or flight" response • Can be caused by too much stress – Life circumstances – Personality • People who have low self-esteem and poor coping skills may be more prone• Certain drugs, both recreational and medicinal, can lead to symptoms of anxiety due to either side effects or withdrawal from the drug.• In very rare cases, a tumor of the adrenal gland (pheochromocytoma) may be the cause of anxiety.
Symptoms of AnxietyAnxiety is an emotion often accompanied byvarious physical symptoms, including:• Twitching or trembling• Muscle tension• Headaches• Sweating• Dry mouth• Difficulty swallowing• Abdominal pain (may be the only symptom of stress especially in a child)
Additional Symptoms of AnxietySometimes other symptoms accompanyanxiety:• Dizziness• Rapid or irregular heart rate• Rapid breathing• Diarrhea or frequent need to urinate• Fatigue• Irritability, including loss of your temper• Sleeping difficulties and nightmares• Decreased concentration• Sexual problems
Physical Reaction to Anxiety Auditory and Visual Stimuli: sights and sounds are processed first by the thalamus, which filters the incoming cues and shunts them either directly to the amygdala or to the other parts of the cortex. Olfactory and tactile stimuli: Smells and touch sensations Bypass the thalamus altogether, Taking a shortcut directly to the Amygdala. Smells, therefore, Often evoke stronger memories Or feelings than do sights or Sounds.
Physical Reaction to Anxiety Thalamus: The hub for sights and sounds, The thalamus breaks down Incoming visual ques by size, Shape and color, and auditory Cues, by volume and Dissonance, and then signals The appropriate part of the Cortex. Cortex: It gives raw sights and sounds meanings, enabling the brain to become conscious of what it Is seeing or hearing. One region, the prefrontal cortex, may be vital to turning off the anxiety response once a threat has passed.
Physical Reaction to Anxiety Amygdala: emotional core of the brain, the amygdala has the primary role of triggering the fear response. information that passes through the amygdala is tagged with emotional significance. Bed Nucleus of Stria Terminalis: unlike the Amygdala, which sets off an immediate burst of fear, the BNST perpetuates the fear response, causing the longer term unease typical of anxiety.
Physical Reaction to Anxiety Locus Ceruleus: It receives signals from the amygdala and is responsible for initiating many of the classic anxiety responses: rapid heartbeat, increased blood pressure, sweating and pupil dilation. Hippocampus: This is the memory center, vital to storing the raw information coming in from the senses along with the emotional baggage attached to the data during their trip through the amygdala.
Social Effects of Anxiety• Depression – Not as involved with family and friends the way you used to be – Lowered quality of relationships – Low energy – Lack of motivation to do the things you once looked forward to doing• Unable to convey the person that you are• Fear and avoidance of situations where previous attacks occurred
Alternative Treatments• Acupuncture• Aromatherapy• Breathing Exercises• Exercise• Meditation• Nutrition and Diet Therapy• Vitamins• Self Love
Medications• Buspirone: shown to be effective but usually takes 3-4 weeks, particularly useful in elderly patients• Benzodiazepines: include Xanax and Valium, act rapidly and successfully but can be addictive and loses effectiveness over time• Side Effects: dizziness, headaches, nausea, impaired memory
Behavioral and CognitiveTherapy• Teaches patient to react differently to situations and bodily sensations that trigger anxiety• Teaches patient to understand how thinking patterns that contribute to symptoms• Patients learn that by changing how they perceive feelings of anxiety, the less likely they are to have them• Examples: Hyperventilating, writing down list of top fears and doing one of them once a week, spinning in a chair until dizzy; after awhile patients learned to cope with the negative feelings associated with them and replace them with positive ones
PsychodynamicPsychotherapy• Psychodynamic therapy is a general name for therapeutic approaches which try to get the patient to bring to the surface their true feelings, so that they can experience them and understand them. Psychodynamic Psychotherapy uses the basic assumption that everyone has feelings held in the subconscious which are too painful to be faced. We then come up with defenses (such as denial) to protect us knowing about these painful feelings.• Psychodynamic psychotherapy assumes that these defenses have gone wrong and are causing more harm than good, making you seek help. It tries to subdue them, with the intention that once you are aware of what is really going on in your mind the feelings will not be as painful.• Takes an extremely long time and is labor intensive
Acupuncture• Caused by the imbalance of chi coming about by keeping emotions in for too long• Emotion effects the chi to move in an abnormal way: when fearful it goes to the floor, when angry the neck and shoulders tighten• Redirects the chi into a balanced flow, releases tension in the muscles, increases flow of blood, lymph, and nerve impulses to affected areas• Takes 10-12 weekly sessions
Aromatherapy• Calming Effect: vanilla, orange blossom, rose, chamomile, and lavender• Reducing Stress: Lavender, sandalwood, and nutmeg• Uplifting Oils: Bergamot, geranium, juniper, and lavender• Essential Oil Combination: 3 parts lavender, 2 parts bergamot, and 1 part sandalwood
Exercise• Benefits: symbolic meaning of the activity, the distraction from worries, mastery of a sport, effects on self image, biochemical and physiological changes associated with exercise, symbolic meaning of the sport• Helps by expelling negative emotions and adrenaline out of your body in order to enter a more relaxed, calm state to deal with issues and conflicts
Meditation• Cultivates calmness to create a sense of control over life• Practice: Sit quietly in a position comfortable to you and take a few deep breaths to relax your muscles, next choose a calming phrase (such as “om” or that with great significance to you), silently repeat the word or phrase for 20 minutes
Nutrition and Diet Therapy• Foods to Eat: whole grains, bananas, asparagus, garlic, brown rice, green and leafy veggies, soy products, yogurt• Foods to Avoid: coffee, alcohol, sugar, strong spices, highly acidic foods, foods with white flour• Keep a diary of the foods you eat and your anxiety attacks; after awhile you may be able to see a correlation• East small, frequent meals
Vitamins• B-Vitamins stabilize the body’s lactate levels which cause anxiety attacks (B-6, B-1, B-3)• Calcium (a natural tranquilizer) and magnesium relax the nervous system; taken in combination before bed improves sleep• Vitamin C taken in large doses also has a tranquilizing effect• Potassium helps with proper functioning of adrenal glands• Zinc has a calming effect on the nervous system
Self Love• The most important holistic treatment of all• Laugh: be able to laugh at yourself and with others; increases endorphin levels and decreases stress hormones• Let go of frustrations• Do not judge self harshly: don’t expect more from yourself than you do others• Accept your faults
Where to Get Help• SFSU Health Center - The services of the Center are open to regularly enrolled (matriculated) undergraduate and graduate students. Office hours are 8AM to Noon and 1PM to 7PM Monday through Thursday and until 5PM on Friday. Appointments may be made by phone (415) 338-2208 or in person at Student Services Building Room 208.• Any licensed psychologist or psychiatrist• U.S. Dept. of Health & Human Services – Substance Abuse & Mental Health Services Administration – find resources in your area http://www.mentalhealth.samhsa.gov/databases
Additional Links• Anxiety Screening Tools• Anxiety Disorders Association of America (ADAA)• Freedom From Fear (www.freedomfromfear.org)• National Institute of Mental Health ( www.nimh.nih.gov)• U.S. Dept. of Health & Human Services ( http://www.mentalhealth.samhsa.gov/topics/explore/s )