Treatment for Anxiety

Everyone experiences nervousness or anxiety under certain circumstances. It might relate to a test situation, a job interview, or coming life changes. In today’s world, especially in big cities like Dubai, there is a great deal of professional and social pressure. Long working hours, family obligations, and no proper life-work balance are the breeding grounds for stress and anxiety.

The step preliminary to treatment of any anxiety disorder is in-depth diagnosis necessary to exclude other psychiatric conditions appearing with similar symptoms.

This article will help you understand the difference between “normal” or “physiological” anxiety and anxiety disorders, such as generalized anxiety, phobias, or panic attacks. You will also find here information on treatment options.

Anxiety in Modern Society

Individuals living and working in big dynamic cities like Dubai, are exposed to high work strees. The have performance reviews and quotas; additionally, many adults face pressure to perform in multiple roles, such as meeting the demands of work, marriage, and being a parent. School age children and college students often feel pressure. Standardized tests, GPAs, and trying to fit in with friends put a high stress on students to perform, above and beyond.

Feeling anxious is a normal reaction to stress. It prompts us to prepare for important events, follow through with assignments and duties, and plan our time carefully. In itself, experiencing anxiety is not a negative thing. A touch of anxiety can serve us well. It gives us the ability to sense danger, be extra careful about our environment, and engage in the “fight or flight” response if in danger. However, the accumulation of stress, long working hours, lack of sleep, and partnership problems can easily overextend an individual’s coping abilities, which might end in an anxiety disorder or depression.

We must keep in mind that there is a real difference between having anxiety in a situation and an anxiety disorder. When someone has a constantly present intense anxiety (generalized anxiety disorder) and/or excessive anxiety coming in waves (panic attacks) will be present with debilitating symptoms.

Many people with anxiety disorder will begin to avoid situations that trigger or worsen their symptoms. This can initiate a vicious circle with damaging effects on a person’s life and emotional health. In order to stop the disorder spiralling down it’s necessary to start the therapy for anxiety which should be provided by a certified health care professional.

Anxiety disorders include disorders that share features of excessive fear and anxiety and related behavioural disturbances.

Categories of Anxiety Disorsers

Fear is the emotional response to real or perceived imminent threat, whereas anxiety is anticipation of future threat. Obviously, these two states overlap, but they also differ. Fears are associated with surges of autonomic arousal necessary for fight or flight reaction. Anxiety is more often associated with muscle tension and vigilance in preparation for future danger and cautious or avoidant behaviours. Sometimes the level of fear or anxiety is reduced by pervasive avoidance behaviours.

Below we list the distinc categories of anxiety disorders. In this article we describe more profoundly only the generalized anxiety disorder.

Panic Attacks and Panic Disorder

Panic Attacks are abrupt surges of intense fear associated with physical discomfort. A panic attack reachs its peak within minutes and last usually few minuets to half an hour and occurs for no apparent reason.

Panic disorder involves repeated panic attacks, causing intense physical and emotional distress. Symptoms can be so severe that people may think they’re having a heart attack. Panic attacks can be triggered or happen unexpectedly. Panic disorder usually begins around ages 20-24 and can coexist with other disorders, like depression or PTSD.

People who suffer from the panic disorder develop strong fears about when and where their next panic attack will occur, increasingly restricting their life activities.

Specific Phobias

Disorders in which panic attacks occur in the context of certain situations or objects are called “phobias.” Individuals with phobias develop over time expectation fears trying to avoid certain places or situations. Although people know their fear is excessive, they feel powerless to control it. This fear may lead them to avoid situations like public speaking, flying, and exposure to narrow spaces, large open spaces or hights. Below few exemples of specific phobias:

Agoraphobia

Individuals with agoraphobia experience fear and anxiety in various situations. These may include using public transportation, being in open or enclosed spaces, standing in a line, or being in a crowd. They may also fear being outside their home alone. These situations evoke anxiety due to concerns about the difficulty of escaping or receiving help in case of panic-like or other debilitating symptoms. Such situations are often avoided and require the presence of a companion, inducing almost constant fear or anxiety.

Claustrophobia

People with claustrophobia avoid situations that trigger their panic and anxiety. For example, they might choose stairs instead of elevators, even if it means climbing many floors. It’s important to know that claustrophobia is a diagnosed condition that can seriously disrupt someone’s life.

Social Phobia

People with social phobia feel extreme anxiety about being judged, embarrassed, or rejected in social settings. They may avoid these situations or endure them with intense fear. Examples include fear of public speaking, meeting new people, or eating in public. The anxiety interferes with daily life and lasts at least six months.

Separation Anxiety Disorder

Separation anxiety disorder involves an intense fear of being apart from close loved ones. It’s beyond typical levels for the person’s age and can last at least four weeks in children and six months in adults. People may avoid going out or have nightmares and physical symptoms when separated from loved ones.

Selective Mutism

Selective mutism affects children who don’t speak in some social settings, like school, but do talk in others, like at home. This can cause problems with learning and social interaction. Many children with selective mutism are very shy and may also have social anxiety. The disorder often begins before age five and may improve as the child grows.

Anxiety in Obsessive-compulsive disorder (OCD)

The Obsessive-Compulsive Disorder (OCD) is characterized by persistent, uncontrollable, and unwanted feelings or thoughts (obsessions) and routines or rituals (compulsions). The affected individuals engage in ritualistic behaviours to try to prevent or rid themselves of the disturbing thoughts and the associated anxiety.

Examples of common compulsions include washing hands or cleaning house excessively for fear of germs. Once the patient stops the rituals, he will immediately experience anxiety. Hence, the cycle continues.

Anxiety in Post-Traumatic Stress Disorder (PTSD)

Suffering severe emotional trauma, such as from a natural disaster or serious accident or crime, may experience PTSD. Thoughts, feelings and behaviour patterns become seriously affected by reminders of the event. Often months or even years after the traumatic experience.

Symptoms such as extreme fear, shortness of breath, racing heartbeat, insomnia, nausea, trembling and dizziness are common in anxiety disorders. Although they may begin at any time, anxiety disorders often surface in adolescence or early adulthood. There is some evidence that anxiety disorders run in families; genes as well as early learning experiences within families seem to make some people more likely than others to experience these disorders.

Generalized Anxiety Disorder

Generalized Anxiety Disorder (GAD) is a common mental health condition characterized by excessive and uncontrollable worries.

Fear is a natural human experience, warning and protecting individuals from threats. However, when anxieties spiral out of control, they develop “life on their own.” Those affected by generalized anxiety find themselves constantly consumed by irrational worries without any particular triggers.

Symptoms of Generalized Anxiety Disorder

Individuals with Generalized Anxiety Disorder experience continuous stream of unrealistic and exaggerated fears not tied to any immediate danger. As a result, people with GAD live in a constant state of apprehension, fearing everything from unfounded worries about their health, their loved ones’ safety, to trivial matters like losing keys. They might also worry about the anxiety itself. The individuals with generalized anxiety live in constant state of emergency which impacts their social and professional performance limiting significantly their life quality.

Generalized anxiety is frequently associated with depression, adding additional burden on the sufferers.

Physical Symptoms Associated wit General Anxiety

In response to anxiety, the body’s release adrenaline, the “fight and flight” hormon preparing the individual to master an imaginative danger. People with generalized anxiety develop physical response typical for the fight and flight reaction such as heart racing, palpitations, sweating and muscle tension. Additional physical symptoms include dizziness, shortness of breath, and gastrointestinal distress. Constant fears cause also sleeplessness, fatigue and decreased concentration.

It’s crucial to distinguish generalized anxiety from panic attacks. While in generalized anxiety the individuals is consistently present, panic attacks occur suddenly, “out of the blue” with symptom free intervals between the attacks.

Causes of Generalized Anxiety Disorder

The causes of generalized anxiety are only partially understood. They likely involve genetic, psychological and environmental factors. Evidence also suggests a genetic predisposition, with some families having a higher incidence of anxiety disorders. Some individuals may have experienced traumatic events in childhood or later in life. Such traumas can be caused by losses of significant others, or prolonged periods of extreme stress related to social or occupational pressure. Life crises can trigger fears that might evolve into a full-blown generalized anxiety. Additionally, generalized anxiety can be comorbid with other conditions like depression, panic disorder, phobias or substance abuse.

Prevalence of GAD

Generalized Anxiety Disorder is a common condition, affecting an estimated 5% of the population at some point in their lives. Women are twice as likely to be affected as men. While the onset typically occurs in mid-adulthood, it can also manifest in childhood or in older age.

Diagnosing Generalized Anxiety Disorder

Diagnosing Generalized Anxiety Disorder can be challenging. Its symptoms may overlap with those of other mental health conditions like phobias, panic disorder, or obsessive-compulsive disorder. Additionally, many affected individuals may experience symptoms more aligned with depression.

The physical symptoms associated with generalized anxiety, such as fears, rapid heart rate, sweating and muscle tension can also occur in conditions like hyperthyroidism or be triggered by stimulating drugs, for example amphetamine.

As a result, reaching a diagnosis of Generalized Anxiety Disorder can be time-consuming, especially if individuals initially seek help due to physical symptoms, perhaps even in an emergency room setting. However, through initial conversations and the necessery diagnostics, professionals can ultimately arrive at the correct diagnosis.

Diagnostic Mesures for General Anxiety Disorder

The process of diagnosing an anxiety disorder begins with a thorough evaluation of the patient’s medical history, known as an anamnesis. The anamnesis gathers crucial information about the onset, nature, and severity of the anxiety symptoms. However, before a definitive diagnosis of an anxiety disorder can be made, the psychiatrist must rule out any underlying physical causes. These could include conditions affecting the lungs, cardiovascular system, or central nervous system. Additionally, the presence of other concurrent mental health problems must be assessed.

A comprehensive diagnostic approach involves a physical examination, laboratory tests, and an Electrocardiogram (ECG) to detect physical illnesses. Depending on the patient’s medical history, specific symptoms, or preexisting conditions, further investigative tests such as lung function tests, electroencephalogram (EEG), or Magnetic Resonance Imaging (MRI) may be recommended.

A diagnosis of “generalized anxiety disorder” is established when anxiety:

• Persists for at least six months, occurring on most days within that period
• Becomes uncontrollable
• Significantly impairs daily functioning
• Is accompanied by at least three physical symptoms, such as a rapid pulse, trembling, muscle tension, or gastrointestinal problems

Treatment of Generalized Anxiety Disorder with Medication

When anxiety is severe or extremely severe, it is important to seek the services of a psychiatrist to establish a diagnosis and consider pharmacotherapy (using medication in addition to counselling).

The fastest treatment for generalized anxiety is the use of medication. The first line of treatment is the use of antidepressants. However, the antidepressants need few weeks to unfold their efficacy. Therefore, the initial use of an anti-anxiety medication with immediate fears reducing effect, called benzodiazepines, might be indicated. In severe cases of anxiety, the common pharmacotherapy requires the combination of antidepressants with benzodiazepines. The latter get obsolete after the effect of antidepressants takes over.

Psychotherapy in Treatment of Generalized Anxiety

The most researched, evidence-based treatment approach of generalized anxiety is cognitive behavioral therapy (CBT). Recent studies also proved the effectiveness of psychodynamic psychotherapy with even fewer relapses compared with CBT.

Typically, in the case of mild or moderate anxiety working with a qualified counsellor, psychologist, or psychotherapist is sufficient. The most researched, evidence-based treatment approach of generalized anxiety is cognitive behavioral therapy (CBT). Other psychotherapy methods effective in treatment of GAD are: Exposure Response Prevention (ERP), Systematic Approximations, and psychodynamic psychotherapy.

Complementary Treatment for GAD

Relaxation techniques, including autogenic training, progressive muscle relaxation, and breathing exercises can be used for treatment of GAD not alone but in combination with psychotherapy and/or medication.

Course of Generalized Anxiety

The course of Generalized Anxiety Disorder typically unfolds gradually, with fears and physical symptoms like heart racing and palpitation, initially going unnoticed. It’s only over time that these symptoms increasingly encroach upon one’s daily life and well-being.

GAD can be remarkably persistent, often taking years to overcome. During this journey, individuals may experience phases of reduced anxiety. The studies show that approximately one in four individuals had recovered from generalized anxiety spontaneously withing 2 years. In long-term, many people do manage their anxieties, and as individuals age, GAD often diminishes naturally.

Living with Generalized Anxiety Disorder

Living with generalized anxiety impacts both professional and personal life. Anxiety impacts the work performance, and the social life of the affected individuals. They tend to withdraw socially, retreating to the safety of their homes, avoiding situations that might exacerbate their anxiety or trigger physical symptoms. In extreme cases generalized anxiety leads to full invalidism.

Opening up about an anxiety disorder is challenging and often limited to the closest circle of family and friends. With therapeutic support, however, it’s possible to share one’s struggles with family members, educating them about the condition and involving them into the treatment.

Seeking professional assistance and support are crucial steps in managing anxiety. It should be stressed out that generalized anxiety is a well treatable disorder, which can be fully curded under the condition of a proper management.

Anxiety Disorders. Summary

Normal anxiety, also called “physiological anxiety” is a part of the human psychic apparatus. Experiencing anxiety under certain circumstances, like exams, a job interview, as well as in dangerous or life-threatening situations is normal. It warns from potential dangers and serves in the “fight or flight” reaction protecting individual’s life. Such “normal” anxiety doesn’t require any treatment.

Anxiety disorders differ from normative fear by being excessive or persistent. In cases where the anxiety appears constantly, like generalized anxiety or in intervals, like panic attacks, we speak about “anxiety disorders.”

There are distinct forms of anxiety disorders from which the most common are Generalized Anxiety Disorder (GAD), Panic Disorder and Phobic Disorders such as Agoraphobia, Claustrophobia, Social Phobia or Flying Phobia.

Diagnosis of Anxiety Disorders

Before commencing the therapy it’s necessary to secure the diagnosis of the anxiety disorder. Diagnosis of an anxiety disorder requires excluding other causes such as psychiatric or physical ilnessess associated with anxiety. the meticulous assessment encompasses medical history, physical examination, and various diagnostic tests to exclude underlying physical causes and ensure an accurate diagnosis.

The treatment for anxiety disorders typically involves a combination of medication and psychotherapy. In mild cases psychotherapy treatment as a stand-alone method might be sufficient. This multifaceted approach is crucial for securing diagnosis and developing an appropriate treatment plan tailored to the individual’s needs.

Generalized Anxiety Disorder

Generalized anxiety is a complex mental health condition characterized by excessive and persistent worries affecting various aspects of life with fears often spiralling out of proportion. In consequence the affected individuals are significantly impaired in their daily functioning and quality of life.

Treatment for Anxiety Disorders

The treatment of anxiety disorders focuses on a quick relief from the symptoms, while gradually reducing the frequency and severity of anxiety episodes. The long-term objective is to achieve for the patient anxiety free life without further necessity of treatment.

Recognizing the symptoms and understanding the causes, are crucial steps toward effective management and treatment. While no treatment method promises a “quick fix,” the treatment with medication provides a quick relive paving the road for the psychotherapy. In less severe anxiety cases the psychotherapy as a stand-alone treatment method.

Over time and under the guidance of a therapist, patients begin to notice improvement within few weeks. By using a proper setting such as long-term psychiatric monitoring and psychotherapy generalized anxiety can be fully cured.

Our German Psychiatric Clinic offers anxiety treatment in Dubai. For more information, call: 971 4 4574240