Anxiety Symptoms and Treatment

Definition and nature.

What is anxiety?

Anxiety is the body’s physiological response, which is set in motion to anticipate situations or stimuli, which the subject considers as a threat or a danger. This response is involuntary.

“In other words, anxiety is a warning signal of the body in potentially dangerous situations.”

Nature of anxiety.

The human being for thousands of years has evolved and adapted to survive in a hostile environment. Our most remote ancestors lived in an environment that has nothing to do with our current society.

For primitive man survival was a primary matter. He had to get his food by hunting. He was stalked by dangerous animals and was exposed to the cold and the rigors of nature.

To live in these extreme conditions was to be exposed to permanent external danger. In order to survive, he had to develop a complex system of alert mechanisms that would prevent him from any imminent danger.

Faced with the threat of attack by an animal, he had only two solutions: flee or fight.

Well, anxiety is the alarm signal of this system. Thus, the organism prepares to react to danger, fleeing or fighting to survive.

Types of anxiety.

We can consider that there are two types of anxiety:

– The physiological, normal or adaptive that alerts us to a real risk situation.

– The abnormal or pathological one , which we will analyze later.

Adaptive Anxiety.

Our caveman was evolving. He developed very complex neural interconnections, to improve and refine responses to danger.

As civilization progressed, these responses were modulated to be proportional to the risks and new threats.

Today, in the 21st century, we are not prepared to fight a mammoth. However, our body reacts quickly when we hear the sound of a horn when crossing a street. In the same way, our brain is activated when we see a stop sign, when we drive a vehicle.

The environment around us is completely different, but nature is wise and has evolved. We have been adapting to changes, preparing ourselves to face current risks.

From this point of view, anxiety is not a bad thing . Rather, it is something that keeps us safe from external threats. Thus, we can safely say that

” A certain degree of anxiety benefits us .”

This physiological anxiety increases our concentration. It protects us and promotes our desire to improve. An acceptable level of anxiety is the engine that drives us to progress and improve ourselves. We call this kind of physiological anxiety adaptive anxiety.

Pathological Anxiety.

The problem arises when that sophisticated mechanism that human beings have developed becomes unbalanced and emits unjustified alarm signals.

If the system becomes so sensitive that danger signals are triggered at all times, the person feels continually threatened and experiences a large number of symptoms that are the reflection of constant fear.

We can say that

“Anxiety becomes a problem when alert mechanisms are triggered unjustifiably.”

When this happens with a very high frequency or with a disproportionate intensity in the face of minimal dangerous situations, we speak of pathological anxiety .

In “Our Psychologist ” we carry out an effective treatment of anxiety disorders.

What are anxiety disorders?

What are anxiety disorders

Anxiety disorders are mental disorders, in which symptoms such as fear or pathological anxiety predominate. They include a wide variety of diseases. Broadly speaking, we can classify them as:

– Acute disorders (where anxiety symptoms appear in isolation).

– Chronic disorders (in these cases pathological fear or anxiety is continuously present in the patient’s life).

Terminology.

Terminology.

There are some terms, related to anxiety, that can be misleading and that are sometimes used indiscriminately, especially at the popular level: anxiety, anguish, stress, generalized anxiety, social anxiety. Let’s look at each of them.

Anguish.

Etymologically the word anxiety derives from the Latin word “anxietas” which means anguish or distress.

The word anguish derives from the German term ” angst “. This term was used by Freud to refer to a painful affective state, which appeared unrelated by any object. That is to say, it did not have a specific or determined origin.

Freud’s original concept of anguish (” angst “) evolved over the years. In his original conception (1984) he considers anxiety as the result of the accumulation of sexual energy or unsatisfied libido.

This initial formulation was varying and adapting to his psychoanalytic theories. In 1932 he ended up defining anguish as an affective state and distinguishing between real anguish and neurotic anguish.

The Freudian concept of anxiety, its development and formulation, are too broad to be treated in this article and deserve a separate chapter due to their complexity.

The Anglo-Saxons translated the German term “ angst ” as “ anxiety ”. In Spanish, the terms anxiety and anguish were adopted as synonyms. At a colloquial level we can say that both terms (anxiety and anguish) are comparable.

They are usually applied to moods that occur with restlessness and restlessness or restlessness, motivated by imprecise situations and that give rise to a pathological fear.

At the scientific level, anxiety would be a specific type of anxiety disorders: the panic attack. The terms are also used panic attacks,  anxiety attacks or “Panik Attack”. This differentiation appears in the DSM-V. It will be seen in more detail when treating this specific pathology.

Definition of the concept of anguish.

Stress.

When speaking of “stress” we find a term that is popularly used with the same meaning as “anxiety”. However, we will see that they do not necessarily mean the same thing.

Stress is more related to an alteration that appears in a subject when interacting with their environment.

We can say that stress appears when environmental factors exceed the capacity of the individual. In this way, the subject is not able to adapt to the environment around him.

When this situation is perpetuated over time, it can lead to anxiety disorders or even situations of distress (panic attack).

Today’s society, with its vertigo, its professional demands and its excessive competitiveness would be the paradigm of a stressful society, since it generates an overload of environmental factors that exceeds the adaptive resources of the subject.

Definition of the term stress

Generalized anxiety.

Generalized anxiety is another of the names by which generalized anxiety disorder or GAD is known , which consists of excessive and constant worry or anxiety throughout the day, without apparent justification.

This situation has a chronic character over time. It will be studied in depth in another article.

Social Anxiety.

The terminology is not always very clear when we talk about anxiety. For example, many people speak of social anxiety to refer to social anxiety disorder, better known as  social phobia .

It is an anxiety disorder where the patient has a constant fear of certain social activities for fear of being observed and judged by others, feeling ashamed and feeling ridiculous.

Epidemiology of anxiety.

Anxiety disorders are perhaps the main reason that brings patients to primary care consultations. Every day more people are looking for a psychologist  specialized in anxiety and its treatment.

The results of the different epidemiological studies can vary considerably, depending on the diagnostic criteria used (DSM-IV-R, DSM-V, ICD-9 or ICD-10). Likewise, the methodological procedure and the observation period (months or years) influence. Despite these differences, which exist,

“We can assure you that anxiety disorders are a serious health problem.”

Let’s look at some data to get a rough idea of ​​the problem. Already in 1994 a study was carried out in the USA on more than eight thousand people. The most relevant data was that more than 17% of the population had suffered from an anxiety disorder in the last year.

The WHO addressed the issue of anxiety with a study of 26,000 subjects from 14 countries. They took the ICD-9 classification as a guide for diagnosis. They made the observations in the primary care consultations and obtained a figure of prevalence of anxiety of 10%, highlighting 8% of generalized anxiety.

Other subsequent studies, carried out in our country, using the DSM-III, have given figures higher than 13%. Without fear of exaggerating the figures,

“We can say that in Spain 20% of people will suffer from an anxiety disorder throughout life.”

This figure gives us an idea of ​​the magnitude of the problem that these disorders represent. But before addressing the treatment of this pathology, let’s see its causes, how it manifests itself and what symptoms it presents.

Anxiety and its causes.

The causes of anxiety are very varied:

  • Genetic factors are not determining factors, but every day more hereditary factors are known that can predispose to the appearance of anxiety disorders.
  • Traumatic factors, physical or emotional, can be of enormous importance, being in fact decisive in some disorders such as post-traumatic stress .
  • The consumption of harmful products can be the origin of anxiety episodes: medicines, drugs , psychoactive foods can induce anxiety disorders.
  • Episodes and experiences of great vital relevance, which involve important changes in the life of the subject, can be the origin of many anxiety disorders.

Causes of pathological anxiety.

Symptoms of anxiety largely depend on the overactivity of the individual’s alarm systems. In this sense, the adrenergic system (the discharge of catecholamines: adrenaline and noradrenaline) plays an important role and is responsible for a large part of the symptoms.

We can divide these symptoms into two broad categories:

Physical symptoms: sweating, palpitations, tachycardia, tremors, dry mouth, feeling short of breath, tightness in the chest, feeling “knot in the stomach”, nausea, vomiting, diarrhea, frequency (need to urinate very often) and many other symptoms.

Psychological symptoms: unfounded worries, fear, feeling of going crazy, fear of suffering a sudden death, forgetfulness, forgetfulness, loss of concentration and memory, irritability and nervousness, obsessions, avoidance behaviors, etc.

As we have seen so far, pathological anxiety is a symptom that can manifest itself in many ways. It is not always obvious to draw a line between normal or adaptive anxiety and pathological anxiety.

This difference has been addressed by the APA (American Psychiatric Association), which in the latest revisions of its Diagnostic and Statistical Manual of Mental Disorders (DSM-IV and DSM-5) states that

“Anxiety will be considered pathological, when fear, worry or its associated somatic symptoms significantly interfere in various areas of the subject’s life or cause significant discomfort”.

Thus, in order to facilitate this difference and see if anxiety has become a disorder, multiple diagnostic tests and scales have been performed, among which the Hamilton anxiety scale and the Goldberg anxiety and depression scale stand out. .

Hamilton Anxiety Scale.

One of the most used psychological tools to assess the degree of anxiety is the Hamilton Anxiety Scale (HEAR). It was designed by Max R. Hamilton and published in the British Journal Medical of Psychology in 1959.

The scale consists of 14 items or questions that the patient must answer on a scale that ranges from 0 to 4. On this scale, each question refers to the intensity of the symptoms (from less to greater severity) or their frequency. (from less to more frequent). The value 4 corresponds to the highest intensity or frequency.

The sum total of the fourteen questions (in the original scale there were 15, but later one was eliminated) gives us the degree of severity of the individual’s anxiety.

Anxiety Disorders: Classification.

Following the criteria established in the DSM-IV, we can consider several anxiety disorders:

In conclusion, since their nature and symptoms are quite different, they will be analyzed separately.

Anxiety attack or panic attack.

Treatment of anxiety.

The treatment of anxiety will vary according to the nature of the disorder, but in most cases it refers to a two-pronged approach:

Pharmacotherapy.

The group of drugs used to treat anxiety are called anxiolytics . It includes a variety of psychotropic drugs, which have been used throughout history. Many of them are no longer used as such or are used for other purposes. Let’s see some of the most used:

  • Barbiturates : Barbital (Veronal), Phenobarbital (Luminal), Secobarbital (Seconal). Today they are in disuse due to the risk of overdoses.
  • Meprobamate , It was displaced by benzodiazepines.
  • Benzodiazepines : Chlodiacepoxide (Librim), Diazepam (Valium), Dipotassium Chloracepate (Tranxilium). Lorazepam (Orfidal), Bromazepam (Lexatin), Alprazolam (Trankimazin), and many others. Benzodiazepines are one of the most widely prescribed and widely used drugs in the world. They can produce both physical and mental dependence. They present with withdrawal syndrome if they withdraw abruptly. They should only be consumed by prescription and for short periods of time.
  • SSRI antidepressants (selective serotonin reuptake inhibitors): Fluoxetine (Prozac), Paroxetine (Seroxat). Sertraline (Besitran), Citalopram (Prisdal). Escitalopram (Cipralex). Although they are antidepressants, they have shown a clear anxiolytic effect. They lack the side effects of benzodiazepines.
  • Lately , membrane stabilizing drugs from the antiepileptic family are being used, such as Gabapentin (Neurontin), Pregabalin (Lyrica) and Lamotrigine (Lamictal) for their secondary anxiolytic action.

Psychological treatment.

  • Cognitive-behavioral therapies: They have been one of the most used techniques. They work on two components: the patient’s thoughts and behavior. Through dual work on these two aspects, we seek to reduce anxiety levels.
  • Psychodynamic therapies: psychodynamic therapies, such as psychoanalysis, have been widely spread in America and some European countries. In Spain its implementation has been later.
  • Psychoanalysis explores the unconscious of the subject, through the interpretation of dreams, the free association of words and failed acts. Its purpose is to bring to consciousness psychic traumas that remain embedded in the unconscious and from there generate anxiety symptoms.

Pharmacological treatment of anxiety.

  • Humanistic psychotherapy: this therapeutic current works with present experiences and with emotions and feelings derived from the complexity of current situations. This psychotherapy has as fundamental pillars the experience, evolution, learning and self-development of the patient. It gives a capital importance to the therapist and patient relationship, as it is the basis for the reconstruction of the life process of the subject.

Likewise, a form of humanistic therapy that is increasingly being accepted is Emotion-Focused Therapy or TFE . It is also known by other names such as Emotional Regulation Therapy.

This therapy was developed by Canadian psychologist Leslie S. Greenberg. It focuses its attention on the management of emotions by the patient. It is a new model of psychotherapy with a solid scientific basis that brings together aspects of the theory of emotions and cognitive therapies.

In our psychotherapy consultation  , anxiety, depending on the type of disorder, is preferably treated with TFE, as it is a type of psychotherapy with very good results in a short period of time.

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Alexa Clark specializes in Cognitive Behavioral Therapy. She has experience in listening and welcoming in Individual Therapy and Couples Therapy. It meets demands such as generalized anxiety, professional, love and family conflicts, stress, depression, sexual dysfunction, grief, and adolescents from 15 years of age. Over the years, She felt the need to conduct the psychotherapy sessions with subtlety since She understands that the psychologist acts as a facilitator of self-understanding and self-acceptance, valuing each person's respect, uniqueness, and acceptance.

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