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Anxiety/Anxiety Disorders

cognitive therapy techniques people feelings generalized dangers

An unpleasant emotion triggered by anticipation of future events, memories of past events, or ruminations about the self.

Stimulated by real or imagined dangers, anxiety afflicts people of all ages and social backgrounds. When the anxiety results from irrational fears, it can disrupt or disable normal life. Some researchers believe anxiety is synonymous with fear, occurring in varying degrees and in situations where people feel threatened by some danger. Others describe anxiety as an unpleasant emotion caused by unidentifiable dangers or dangers that, in reality, pose no threat. Unlike fear, which is caused by realistic, known dangers, anxiety can be more difficult to identify and to alleviate.

Rather than attempting to formulate a strict definition of anxiety, most psychologists simply make the distinction between normal anxiety and neurotic anxiety, or anxiety disorders. Normal (sometimes called objective) anxiety occurs when people react appropriately to the situation causing the anxiety. For example, most people feel anxious on the first day at a new job for any number of reasons. They are uncertain how they will be received by co-workers, they may be unfamiliar with their duties, or they may be unsure they made the correct decision in taking the job. Despite these feelings and any accompanying physiological responses, they carry on and eventually adapt. In contrast, anxiety that is characteristic of anxiety disorders is disproportionately intense. Anxious feelings interfere with a person's ability to carry out normal or desired activities. Many people experience stage fright—the fear of speaking in public in front of large groups of people. There is little, if any, real danger posed by either situation, yet each can stimulate intense feelings of anxiety that can affect or derail a person's desires or obligations. Sigmund Freud described neurotic anxiety as a danger signal. In his id-ego-superego scheme of human behavior, anxiety occurs when unconscious sexual or aggressive tendencies conflict with physical or moral limitations.

Anxiety disorders afflict millions of people. Symptoms of these disorders include physiological responses: a change in heart rate, trembling, dizziness, and tension, which may range widely in severity and origin. People who experience generalized anxiety disorder and panic disorders usually do not recognize a specific reason for their anxiety. Phobias and obsessive-compulsive disorders occur as people react to specific situations or stimuli. Generalized anxiety disorder is characterized by pervasive feelings of worry and tension, often coupled with fatigue, rapid heart rate, impaired sleep, and other physiological symptoms. Any kind of stress can trigger inappropriate, intense responses, and panic attacks can result. People suffering from generalized anxiety experience "free-floating" fears, that is, no specific event or situation triggers the response. People keep themselves on guard to ward against unknown dangers.

It is believed that generalized anxiety disorder is, at least to some extent, inherited, or is caused by chemical imbalances in the body. Depending on the severity of the symptoms and the responsiveness of the patient, treatment may vary. Often, drugs in the benzodiazepine family (Valium, Librium, and Xanax) are prescribed. These drugs combat generalized anxiety by relaxing the central nervous system, thus reducing tension and relaxing muscles. They can cause drowsiness, making them an appropriate treatment for insomnia. In proper dosages, they can relieve anxiety without negatively affecting thought processes or alertness. Medication is most effective when combined with psychological therapies to reduce the risk of recurrence. Behavior therapy is designed to help modify and gain control over unwanted behaviors by learning to cope with difficult situations, often through controlled exposures to those situations. Cognitive therapy is designed to change unproductive thought patterns by learning to examine feelings and distinguish between rational and irrational thoughts. Relaxation techniques focus on breathing retraining to relax and resolve the stresses that contribute to anxiety.

Controlling or eliminating the physical symptoms of anxiety without medication is another method of treatment.

Factor 0 points 1 point 2 points
Heart rate No heartbeat Under 100 beats per minute Over 100 beats per minute
Respiration Not breathing Irregular, with weak cry Regular with strong cry
Muscle tone Limp, no movement Limited movement of the limbs Active movement of the limbs
Color Completely blue, pale Pink body with blue hands and feet All pink
Reflexes No response to being poked in the nose Grimace when poked Cry, cough, or sneeze when poked

For example, practiced breathing techniques can slow the heart rate. Access to fresh air can ease sweating. Effective control of such symptoms can be useful in controlling the anxiety itself. Psychotherapy is another method of treating generalized anxiety disorder and is used in conjunction with drug therapy or in cases where medication proves ineffective. While there is no definitive cause for the disorder, communicating their feelings to a sympathetic therapist helps some people reduce their anxiety.

Further Reading

Amen, Daniel G. Change Your Brain, Change Your Life: The Breakthrough Program for Conquering Anxiety, Depression, Obsessiveness, Anger, and Impulsiveness. New York: Crown Publishing Group, 2000.

Goodwin, Donald W. Anxiety. New York: Oxford University Press, 1986.

Zimbardo, Philip G. Psychology and Life. 12th ed. Glenview, IL: Scott, Foresman, 1988.

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