Fear is a natural human experience, warning and protecting individuals from threats. 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 tremendous 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 an in-depth diagnosis necessary to exclude other psychiatric conditions appearing with similar symptoms.
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This article helps to understand the difference between “normal” or “physiological” anxiety and anxiety disorders, such as generalized anxiety, phobias, or panic attacks.
The text also explores the symptoms, causes, and treatment options for anxiety in Dubai.
Read more about anxiety disorders:
- Generalized Anxiety Disorder
- Treatment for Panic Attacks
- History of Panic Attacks. Developing the Diagnosis
- Flying Phobia. The Fear of Flying
- Claustrophobia. Symptoms, Causes and Treatment
- Agoraphobia. Diagnosis and Treatment
- Treatment for Social Phobia
Anxiety in Modern Society
Individuals living and working in big, dynamic cities like Dubai are exposed to high work stress. They 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.
Physiological Anxiety versus Anxiety Disorders
We must keep in mind that there is a real difference between having anxiety in a situation and having an anxiety disorder. When someone has a constantly present intense anxiety disorder and/or excessive anxiety coming in waves (panic attacks), they 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 spiraling down, it’s necessary to start the therapy for anxiety, which should be provided by a certified health care professional.
Anxiety disorders include conditions that share features of excessive fear and anxiety and related behavioural disturbances.
Types of Anxiety Disorders
Fear is the emotional response to a real or perceived imminent threat, whereas anxiety is the anticipation of a future threat. Obviously, these two states overlap but also differ. Fears are associated with surges of autonomic arousal necessary for a 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 distinct categories of anxiety disorders. In this article, we describe more profoundly only the generalized anxiety disorder.
Generalized Anxiety Disorder (GAD)
People with generalized anxiety disorder (GAD) suffer from a constant feeling of worry and tension about everyday events and problems. Their concerns often revolve around areas that others might also worry about. However, for individuals with GAD, these worries are much more intense and pronounced.
For diagnosis of GAD, the anxiety symptoms must persist for at least six months and significantly impact daily life. Common symptoms include heart palpitations, excessive sweating, dizziness, and a constant sense of nervousness. Many individuals also report stomach discomfort, muscle tension, and difficulty concentrating.
The condition often affects sleep, making it hard to fall asleep or stay asleep throughout the night. In more severe cases, individuals may experience an overwhelming fear of losing control, “going crazy,” or even dying.
Panic Attacks and Panic Disorder
Panic attacks are abrupt surges of intense fear associated with physical discomfort. A panic attack reaches its peak within minutes and lasts usually a few minutes 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, for example, flying. 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 heights. Below are a few examples 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)
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 the 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 cause 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.
Treatment for Anxiety Disorders with Medication at CHMC Dubai
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 anxiety is the use of medication. The first line of treatment is the use of antidepressants. However, the antidepressants need a few weeks to unfold their efficacy. Therefore, the initial use of an anti-anxiety medication with an immediate fear-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.
There are many controlled studies on the use of medications for anxiety, showing response rates between 44% and 81%. However, in the long run, it’s always recommended to combine medication with psychotherapy for optimal results.
General Considerations
All medication-based treatments require careful medical supervision and guidance from the prescribing doctor. Side effects, particularly at the start of treatment, may be challenging, especially as therapeutic benefits are not immediate.
Educating patients about common side effects—such as initial restlessness when starting treatment with antidepressants—can improve adherence. Explaining the delayed onset of antidepressant effects (2–6 weeks) also helps to maintain the compliance.
Selective Serotonin Reuptake Inhibitors (SSRIs)
Medications like Escitalopram, Paroxetine, and Sertraline have been shown to be effective in controlled studies.
- Common Side Effects: Initial restlessness, nervousness, or increased anxiety; long-term use may lead to sexual dysfunction or discontinuation symptoms (though less severe than benzodiazepine withdrawal).
- Administration: Best taken in the morning to reduce sleep disturbances.
- Onset of Effect: 2–6 weeks.
Selective Serotonin-Norepinephrine Reuptake Inhibitors (SNRIs)
Medications like Venlafaxine (typically in extended-release form) and Duloxetine are effective for GAD.
- Common Side Effects: Nausea, restlessness, or sleep problems during the initial phase.
- Onset of Effect: 2–6 weeks, sometimes longer.
Tricyclic Antidepressants (TCAs)
Imipramine is an option for GAD but generally less preferred due to higher rates of side effects compared to SSRIs and SNRIs.
- Common Side Effects: Increased anxiety at the start, sedation, weight gain, and anticholinergic effects.
- Onset of Effect: 2–6 weeks or longer.
- When Used: Typically considered only when other standard medications fail or are not tolerated.
Benzodiazepines
Examples include Alprazolam, Diazepam, and Lorazepam.
- Benefits: Rapid relief of anxiety symptoms, making them suitable for acute phases.
- Risks: Sedation, dizziness, impaired reaction time, and potential dependence after prolonged use (4–8 months).
- Use: Short-term (4–8 weeks) to manage acute symptoms, often alongside antidepressants to bridge their delayed onset. Not suitable for patients with a history of substance abuse.
- Limitation: Minimal impact on coexisting depressive symptoms.
Other Medications used for Treatment of Anxiety
- Buspirone: Some studies show effectiveness, but it is less effective than SNRIs and comparable to placebo in certain cases.
- Hydroxyzine: Effective in short-term studies but lacks evidence for long-term relapse prevention.
- Opipramol: An anxiolytic similar to TCAs, found to be more effective than placebo and comparable to Alprazolam in one study. Long-term data are lacking.
- Quetiapine: An atypical antipsychotic effective at low doses for GAD, though not officially approved for this use. Reserved for cases where standard treatments fail.
- Agomelatin: A newer antidepressant with some efficacy in GAD, not yet approved for this condition. Requires liver function monitoring due to potential liver toxicity.
Psychotherapy in Treatment for Anxiety Disorders
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 for generalized anxiety is cognitive behavioural therapy (CBT). Other psychotherapy methods effective in the treatment of GAD are exposure response prevention (ERP), systematic approximations, and psychodynamic psychotherapy.
Cognitive Behavioral Therapy (CBT) at CHMC Dubai
CBT not only helps reduce anxiety but can also alleviate other issues, such as depression, that often accompany anxiety disorders. However, since the therapy involves actively confronting one’s fears, the treatment itself can sometimes be challenging. In general, the potential side effects of psychotherapy have not been thoroughly studied.
Depending on availability and technical resources, these sessions can also be conducted virtually via videoconferencing.
Goals of CBT
CBT consists of two main components: a cognitive part, which focuses on thoughts and emotions, and a behavioral part, which addresses actions and reactions.
The goal of the cognitive approach is to change anxiety-inducing thought patterns by:
- Recognizing and challenging unrealistic fears and worries.
- Accurately assessing the real likelihood and consequences of feared events, and
- Coping with uncertainty.
Unwinding Catastrophizing
One example of anxiety-driven thought patterns is catastrophizing—immediately jumping to extreme, exaggerated conclusions about the severity of a perceived threat when something concerning happens. With the help of a therapist, patients learn to identify these thoughts and work on reducing their impact or managing them better. Ultimately, CBT helps individuals think more clearly and gain better control over their thoughts.
Desensitization
The second part of therapy focuses on gradually reducing anxiety in specific situations by changing behaviors. This involves actively confronting fears to overcome them step by step. For example, a working mother who frequently calls the daycare to check on her child may learn to reduce the number of calls over time. To make these behavioral changes easier, therapy also includes strategies to stay calm, such as breathing exercises and relaxation techniques. Digital tools, such as a journal for tracking emotions on a smartphone or tablet, can also be integrated. Additionally, guided relaxation exercises can be accessed online, allowing individuals to practice them at home when it best fits their routine.
Internet-Based CBT (iCBT)
In recent years, studies have explored internet-based CBT. These treatments involve either self-guided therapy through various media or therapy supported by brief therapist contact via email or phone. Results show significant improvements compared to waitlist controls, except in one study where iCBT and internet-based psychodynamic therapy did not differ from waitlist outcomes. However, due to the lack of direct comparisons with traditional in-person CBT, internet therapy cannot currently be recommended. Practical and ethical concerns (e.g., managing suicidal patients) also limit its applicability.
Psychodynamic Approaches in Treatment for Anxiety
Psychodynamic psychotherapy is one of the most researched and leading therapeutic methods worldwide. When applied correctly, it can be highly effective in treating anxiety disorders. Significant improvements can often be achieved within 10 to 25 sessions.
The core idea is to understand why symptoms appear at a specific time. Once symptoms are understood, seemingly “unsolvable” conflicts can suddenly become manageable through this approach.
The psychodynamic approach is not a single technique but a broad theoretical framework. Different in-depth psychotherapies have proven effective for anxiety, panic attacks, and agoraphobia. The choice of therapy technique depends heavily on individual goals and needs. The best therapy method can be determined during initial consultation sessions.
Complementary Treatment for Anxiety Disorders
Relaxation techniques, including autogenic training, progressive muscle relaxation, and breathing exercises, can be used for the treatment of anxiety not alone but in conjunction with psychotherapy and/or medication.
Treatment for Anxiety in Dubai. Summary
Normal anxiety, also called “physiological anxiety,” is a part of the human psychic apparatus. Experiencing anxiety under certain circumstances, like exams or a job interview, as well as in dangerous or life-threatening situations, is normal. It warns of potential dangers and serves in the “fight or flight” reaction, protecting an 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, of which the most common are generalised 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 illness 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.
Recognizing the symptoms and understanding the causes are crucial steps toward effective management and treatment.
Treatment for Anxiety Disorders
The treatment for anxiety disorders typically involves a combination of medication and psychotherapy. While no treatment method promises a “quick fix,” the treatment with medication provides faster relief, paving the road for the psychotherapy. In less severe cases, the psychotherapy is a stand-alone treatment method. The long-term objective for the patient is to achieve an anxiety-free life without further relapses.
Over time and under the guidance of a therapist, patients begin to notice improvement. By using a proper setting such as long-term psychiatric monitoring and psychotherapy, anxiety can be fully cured.
FAQ about Anxiety
This section of frequently asked questions provides the answers to the most common queries about anxiety disorders and when to get help.
I feel anxious…
Question:
I live in Dubai. For a few weeks, I have felt anxiety. There is nothing in my life that could explain such feelings. My mother suffered from anxiety, and she is taking an antianxiety medication. I don’t want to get addicted to any medication. Where can I find a counsellor in Dubai?
Answer:
Psychotherapy is a highly effective treatment method. It could be used alone if your anxiety is not constantly present or is not very severe. In case of severe anxiety affecting your private and professional life, we would suggest suppressing the anxiety with medication, such as antidepressants, while doing in parallel the psychotherapy. It doesn’t mean that you must take the medication endlessly. In cases of severe anxiety, the combined therapy method is the most effective strategy for decreasing the total length of the treatment.
I feel anxiety while driving in Dubai…
Question:
I frequently feel anxious and get heart palpitations while driving in Dubai. In my home country the traffic is not so dense, so I don’t know if this is “my Dubai traffic anxiety.” I must commute, but I’m getting increasingly scared driving a car. Is there a medication that can help me get rid of the anxiety quickly?
Answer:
The anxiety you describe is triggered by external circumstances (in your case, driving). It can be, in fact, the denser traffic; nevertheless, the anxiety affects your social or professional performance. So, there is no other option but to start the treatment as soon as possible.
The first choice would be the treatment with medication. Such treatment is highly effective in the short and middle term. In most cases, the right medication can suppress the symptoms completely. In the second step, counselling should take place.
Combining medication and psychotherapy is the most effective treatment method. Simplifying the treatment strategy: medication allows you to suppress/remove the symptoms, and the counselling helps to remove the medication while keeping you still symptom-free.
What is anxiety?
Anxiety arises as a natural reaction to stress or perceived threats, marked by sensations of fear, worry, or apprehension. While occasional bouts of anxiety are typical, consistent or overwhelming anxiety that disrupts daily functioning could signal an anxiety disorder.
What are the different types of anxiety?
Anxiety disorders include generalized anxiety disorder (GAD), panic disorder, social anxiety disorder (social phobia), specific phobias, and others. Each type of anxiety disorder has its own set of symptoms and triggers.
What are the symptoms of anxiety?
Symptoms of anxiety can vary but may include excessive worrying, restlessness, irritability, muscle tension, difficulty concentrating, and sleeplessness disturbances. Physical symptoms such as rapid heartbeat, sweating, trembling, and gastrointestinal issues may also occur.
What causes anxiety?
Anxiety disorders can result from a combination of factors, including genetics, brain chemistry, personality, life experiences, and traumatic events. Certain medical conditions and substance use may also contribute to anxiety.
How is anxiety treated? What are the treatment options in Dubai?
Anxiety disorders are typically treated with a combination of psychotherapy and medication. The treatment can typically happen in an outpatient setting in one of the clinics in Dubai. The psychotherapy method of choice is cognitive-behavioural therapy (CBT). In more severe cases, we recommend the use of medication. The treatment with medication, typically with antidepressants, lasts a few months, is not addictive, and can completely remove the anxiety, restoring normal life quality.
Can anxiety cause chest pain?
Yes, anxiety can cause chest pain. When a person experiences anxiety, the body’s stress response is activated, leading to various physical symptoms, including muscle tension and increased heart rate. This tension can sometimes manifest as chest pain or discomfort, which may feel like tightness, pressure, or aching in the chest. It’s essential to consult a healthcare professional to rule out any other potential causes of chest pain and to receive appropriate management for anxiety-related symptoms.
Can anxiety be cured?
Anxiety disorders can be effectively treated with appropriate treatment. The majority of anxiety disorders can be cured without the necessity of further treatment, most often by using a combined treatment: psychotherapy and medication. In some cases, a low dosage of medication might be used as a prophylaxis, providing protection from relapse. By a very small percentage of patients, the intensity and frequency of anxiety can be significantly reduced; however, continued anxiety treatment will be indicated.
I feel anxious without any reason. What to do?
Question:
I lived in Dubai for five years. A few months ago, I started to feel anxious while experiencing tightness in the chest. I didn’t find any reason for the anxiety. I thought that I might have something on my lungs; that’s why I feel anxious. However, the internal medicine doctor didn’t find any problems with my lungs or heart. I think I have anxiety. When can I get help in Dubai?
Answer:
If an organic problem such as asthma or some problems on your heart were excluded, then you probably have an anxiety disorder. In such a situation, it’s essential to seek help from a qualified mental health professional. Our psychiatrist or psychologist can assess your symptoms, provide a diagnosis, and recommend an appropriate treatment plan tailored to your needs.
Managing anxiety without medication?
Question:
I live in Dubai and suffer from anxiety in crowded places and while interacting with groups of people. I know that some medication, such as anti-anxiety medication, is prohibited. Can I get rid of my anxiety without using medication?
Answer:
Let’s first clarify our worries about using medication for the treatment of anxiety in Dubai. Medication used for treatment of anxiety in Dubai is semi- or fully controlled and can be only prescribed by a psychiatrist.
A mild level of anxiety can be managed without medication through various therapeutic techniques such as psychotherapy, relaxation exercises, mindfulness, and lifestyle modifications. However, in some cases, medication may be necessary for symptom control. In more severe cases of anxiety, the most effective treatment method involves a combination of medication and psychotherapy.
What happens when I don’t treat my anxiety?
Untreated anxiety can lead to significant impairment in various areas of life, including work, relationships, and physical health. It may also increase the risk of developing other mental health conditions, such as depression and substance abuse disorders. Seeking timely treatment can help prevent these long-term consequences.
What is the difference between panic attacks and constantly present anxiety?
While both panic attacks and generalized anxiety involve feelings of fear and discomfort, they differ in intensity and duration. Panic attacks are sudden, intense episodes of fear or panic that typically peak within minutes, accompanied by physical symptoms like rapid heartbeat and shortness of breath. The constantly present anxiety, or generalized anxiety disorder, on the other hand, involves persistent feelings of worry, nervousness, or unease that may vary in intensity over time.
At CHMC, we are here to guide you every step of the way. Contact our specialists for professional help with anxiety: