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Anxiety disorders are remarkably common. Epidemiological studies have found that in one year, 17-24% of the examined population experienced an anxiety disorder
This makes it a sizable and respected "club" that many may belong to at some point in their lives. On the other hand, anxiety is also a natural and widespread emotion.
Natural anxiety is the feeling we sometimes get when we sense danger, watch a scary movie scene, are highly concerned about an undesired outcome, or feel embarrassed when speaking in front of a crowd. It's the feeling we experience before an exam or the discomfort we might feel when discussing a sensitive topic. This emotion often serves as a warning sign for conflicting decisions or actions that do not align with our values.
A balanced level of natural anxiety is entirely normal. An excess or lack of anxiety (indifference) can lead to functional impairment. In all these situations, we expect the feeling to be temporary, fleeting, and tolerable. Another example of anxiety situations includes scenarios where there is a real risk or a perceived risk to our lives, such as "near-miss accidents" or residents of Gaza and Sderot experiencing "Red Alert" sirens.
Anxiety disorders, in contrast to natural anxiety, are medical conditions where anxiety is a central expression, but typically, its intensity is heightened and does not match the situation. These disorders impair the quality of life, cause subjective distress, and affect the level of basic functioning. In anxiety disorders, there is a sense of fear even in situations where there is no real danger or the danger is not as intense as the emotional response suggests. These disorders can occur spontaneously or after various events, are more common in women, and having a family history of anxiety increases the likelihood of experiencing them.
The physical signs of anxiety disorders include heightened alertness, chest pains, heart palpitations, dry mouth, increased urination frequency, abdominal discomfort, and more.
The psychological and cognitive signs encompass excessive worry, fear, lack of security, catastrophic thinking, negative thought reinforcement (turning a molehill into a mountain), and heightened fears of physical illnesses.
Behavioral signs include cautious behavior, tendency to panic, and various forms of avoidance. This is an attempt to protect oneself from perceived threats. People suffering from anxiety disorders may avoid traveling due to fear of accidents, refrain from leaving the house to avoid embarrassment or risk, avoid social interactions for fear of disappointment, or refrain from discussing illnesses out of fear. These signs can manifest in various health and illness states, and we consider them a medical condition and diagnose them only when their intensity is high, the duration of the problem is long-lasting (several weeks or more), and the signs and disturbance cause suffering and impair basic functioning.
Panic disorder is one of the clinical pictures of anxiety disorders, characterized by short episodes of intense panic or anxiety accompanied by chest tightness, heart palpitations, warmth waves, shivering, nausea, butterflies in the stomach, and sometimes numbness or tingling in the hands. The feeling during those 10-20 seconds of an attack can be terrifying, despite no actual danger being present. Usually, people with this condition are very concerned about a heart attack and rush to seek immediate medical attention, only to find that there is no cardiac problem. Over time, a pattern of thinking develops with concerns and worries about additional attacks, leading to avoidant behaviors like fear of leaving the house, agoraphobia, and isolation. In some cases, excessive medical testing for fear of physical illness occurs (in such cases, it's better to refer to the physical symptoms as expressions of tension or anxiety rather than saying "you have nothing"). Depression may also develop in the future. Usually, this course lasts for several months and decreases or disappears with treatment. Relapses may occur in the future, usually with lower intensity.
In this disorder, the primary expression is excessive worrying. The anxiety is high, exaggerated, and prolonged. Alongside the worry, there is a high level of physical and psychological tension, with physical symptoms such as fatigue, back and shoulder pain, high muscle tension, gastrointestinal complaints, sleep disturbances, and difficulty relaxing due to feeling the need to be "on guard" at all times.
Typically, individuals with this condition are overly concerned about their family members. They often insist on knowing the whereabouts and well-being of each family member every hour of the day. Sometimes, the family collaborates with the disorder, providing constant updates and reports that "everything is okay."
People with this condition do not usually recognize it as a problem, seeing themselves as reacting realistically to environmental threats. In practice, the disorder becomes a personal trait, and individuals do not view it as a problem, saying, "I'm just always worried, always finding reasons to be anxious about everything." Consequently, many people with this disorder do not seek treatment, or they do so due to overwhelming distress.
Despite this, many still suffer. Their quality of life is diminished, and they frequently consult physicians due to physical symptoms. They bear a constant burden of ongoing tension.
There is hope for both expressions of anxiety that have been described! Treatment can be divided into two categories: psychotherapeutic talk therapy and pharmacological treatment.
The goal of talk therapy is to teach individuals to live life according to its opportunities, rather than being consumed by the fear of danger, and ultimately to overcome the problem altogether.
Talk therapy is based on the premise that understanding and familiarity with the problem and its sources – whether they are historical, psychological, cognitive, or behavioral – can lead to improvement. Psychotherapeutic treatment involves acquiring knowledge about the problem, learning techniques to reduce tension, and managing physical manifestations of anxiety.
A portion of the treatment focuses on catastrophic anxious thinking and offers techniques for identifying and preventing such thinking, as an alternative to the current worldview.
Another aspect of treatment is addressing behaviors and avoidance patterns associated with anxiety disorders. For example, when treating a woman with generalized anxiety, she may be asked to practice reducing the number of phone calls she makes to check on her family members without causing undue distress.
In other talk therapy treatments, the focus may be on understanding how anxiety affects the individual's life, examining the origins of anxiety in their past, personality, and its impact on their relationships and interactions with the environment.
In most therapy sessions, individuals will explore the limits of their ability to control their lives and potential threats. They will also recognize the need to accept "partial control" over what happens in their lives as a part of reality.
Additionally, returning to physical activity can be helpful, and relaxation techniques such as slow breathing and guided imagery can be highly beneficial. Relaxation and therapeutic relaxation techniques are often emphasized in complementary therapies.
Pharmacological treatment includes anti-anxiety and anti-depressant medications such as Prozac, Lexapro, and Effexor, which are taken regularly for periods ranging from months to years. These medications, known as selective serotonin reuptake inhibitors (SSRIs), are most effective for the majority of patients after continuous treatment for about a month.
Another group of medications used for anxiety disorders consists of anxiolytics, including Alprazolam, Clonazepam, and Lorazepam. These drugs can provide relief from anxiety within one to two hours for various types of anxiety, whether natural or pathological, as part of an anxiety disorder. It is advisable to use them for a short duration, typically 2-6 weeks, or for specific situations where anxiety is particularly overwhelming.
While in most anxiety disorders, the first group of medications (SSRIs) is preferred, in generalized anxiety disorder, a combination of psychotherapy and the latter medications is often recommended. The success of the treatment is more significant when psychotherapy and pharmacological treatment are combined.
It is important to note that for some individuals, ongoing medication for anxiety is necessary to live and function effectively without problems. This is similar to ongoing treatment for high blood pressure or high cholesterol. Critical judgment or blame directed at the individual for using long-term medication is unwarranted. It should be viewed as regular treatment for a medical problem that does not require stigmatizing scrutiny. There should be no hesitation in discussing periodically with the treating physician the benefits and drawbacks of continuing treatment.
Two common anxiety disorders have been described here, both of which can cause suffering, impair the quality of life, and affect functioning. Nevertheless, many people do not seek treatment. Some believe that there is no treatment for their condition, while others are apprehensive about seeking help from a psychologist or psychiatrist, feel embarrassed to disclose their problem to a family doctor, or simply do not recognize it as an issue. Friends, family, and medical professionals need to consider whether excessive anxiety is present and suggest seeking assistance from a qualified professional to determine if it is a disorder that requires treatment.
