What are you going to do if you think that you have an anxiety disorder?
Well it’s no good just sitting there worrying about it because you are already worrying too much !
It’s time to take some action and sort this thing out and you might need some help but the good news is that most types of anxiety can be sorted out one way or another.
The first thing to do is to make an appointment with your doctor.
That is the easy bit. It’s only a quick telephone call and that is stage one over. You could try and go it alone but there is absolutely no shame in going to see your doctor in total confidence and getting checked out. He or she can confirm whether you are suffering from simple anxiety or an anxiety disorder.
You will have a starting point, a base to work from – you will know what is wrong with you and that’s half the battle right? Believe it or not, having a confirmed diagnosis can sometimes make the condition much less distressing!
Step two is actually keeping the appointment which may be a little harder but if you’ve completed step one i.e. made the appointment you might just as well carry through otherwise you will have wasted your valuable time at stage one !
Now your doctor will assess you and suggest a strategy for helping you. It is also important (step 3) to find out as much as you can about anxiety and you are doing a little of that by reading this.
With knowledge comes understanding and control can emerge from understanding.
It is very important to know that you are not alone. There will be hundreds if not thousands of people all feeling the same as you. It may be possible to join some sort of local group get some release by talking to others. Your doctor may be able to help with this.
You will find that your doctor is a good listener and make sure you tell him all of your symptoms and how they affect your life. Just talking to your doctor like this may help enormously.
If your doctor feels that your problem may be a little harder to tackle, he may decide to suggest one or both of two options and it is important that you decide together with your doctor which is best for you. If you are not happy about taking up his recommendation then it’s clearly not going to work. You have to “buy into” into the recommendation. He may suggest some sort of medication or talking to someone who specialises in this area; a therapist.
So help with anxiety disorders comes in three forms. Helping yourself, therapy, or medication. The choice will depend on the severity of your symptoms and your treatment strategy should be an agreement between you and your physician.
Help yourself ?
Get ready for future events.
You may be anxious about a future event such as having to give a talk in public, flying in an aeroplane, a court appearance etc.
What you need to do is to gather as much information and experience of the event in advance so that there are fewer "unknowns".
So for example, if you are giving a talk or a speech, then you could reduce your stage fright by firstly knowing your subject inside out.
You could for example write out the speech and simply read it from the sheet. That way you know you are not going to be stuck for words although your speech may not be the most engaging !
Find out about your audience. How many people are likely to attend ? What questions are they likely to ask? What is the venue? Can I visit the venue in advance and stand on the stage or wherever? This is a powerful way of introducing the anxious brain to the thought of doing the talk.
You have to think the whole thing through and take it step by step and practice talking in a mirror to satisfy yourself that you at least look relaxed. Practice practice practice. Remember the old saying - "failing to prepare is preparing to fail! " It is not a good idea to avoid the situation that is leading to your anxiety because that will reinforce the problem and you will find it easier to use avoidance in the future.
Talk about your fears and anxieties. Talk to friend's and relations. "A trouble shared is a trouble halved" - This is so true.
Simply talking about your anxiety, vocalising it really can reduce the severity. The chances are that whoever you talk to will have experienced similar feelings. You may be able to find a support group locally - check out the yellow pages. By finding and joining a group of people who are all suffering from the same problem can lessen it's impact. This is the same principal at work with Alcoholics Anonymous.- There is comfort is sharing and belonging.
You must look after yourself. You must make an effort to keep well and healthy. Make an effort to focus on :
Nutrition: Eat healthily- plenty of fruit and vegetables - Aim for at least five portions each day and get the rest of your calories from carbohydrate and protein with only a little fat.
Ask your physician or pharmacist to work out your BMI and knowing your height, calculate your target weight and set yourself the goal of achieving it. Drink at least five glasses of water each day.
Exercise: It might be best to check with your physician first before undertaking an exercise programme but assuming it is ok: adults for example should aim to exercise for 30 minutes a day five days a week. (For weight loss, 60 -90 minutes per day of physical activity are recommended).
Bur do what you can. Make a start and build on that.
Rest: Most of us need between 7 and 9 hours sleep each night. Sleeping is the body's opportunity to repair itself. What's god for the body is also good for the mind. The brain needs to rest too. Too much sleep can however be detrimental. Don't lay in bed all day !
If you are unemployed then set yourself a routine, keep busy.
Relaxation is important too. Stress can lead to anxiety so finding ways to keep calm will help like for example listening to music, pursuing a hobby, reading or watching a movie.
Try thinking in boxes. Identify what areas of your life are causing you the most stress and minimise them. It seems simplistic but it can help to think of them in boxes. Deal with them one at a time and don't allow the contents of one box to spill into another. If you have problems at work, then once you are at home, know that you've left it behind and enjoy your time at home.
What about therapy?
Helping yourself may not be the whole answer and therapy is another option for treatment.
Psychological therapy or psychotherapy
Psychotherapy is a method of dealing with a problem using an interaction between the sufferer and the therapist.
The techniques used are many and varied. Finding a therapist is easy - you just have to pick up the yellow pages.
But which one is right ? Beware - anyone can call themselves a therapist so you will need to check them out. Find out what their qualifications are. Go see them and see if you like them. You are more likely to get some benefit from your therapist if you have a rapport with them.
Therapists come in many shapes and sizes and what I mean by that is the techniques they use to help take many forms from talking one to one, to group therapy, music therapy, art therapy, basically - you name it- someone will be offering it. You may be wisest to get a referral or recommendation from your physician.
Cognitive Behavioural Therapy (CBT).
CBT is a very powerful technique which can work quickly in as little as four sessions of an hour. Some people require more usually up to about 20 -25 sessions.
CBT is a technique which uses two approaches.
The cognitive bit refers to where the therapist tackles your perceptions about things. the therapist attempts to make you see things the way they really are rather than how you think they are. he or she will use logic to try and make you realise that your
perceptions are wrong or at the least exaggerated.
The Behavioural bit is where the therapist explores your reaction to situations and attempts to modify them. For example if you have a phobia of spiders, your therapist might show you a picture of a small part of a spider and if you start to show symptoms of anxiety, talk to you and help you overcome the anxiety.
When you are able to look at the picture with your symptoms under control then you might be shown a picture of a whole spider and you would then be helped to control your symptoms.
You might then be exposed to a small spider in a glass box and again given help to control symptoms. The process would continue for example until you were able to handle a live spider.
So CBT for fear of spiders would involve both the behavioural bit using the desensitising process and the talking and analysis of symptoms bit slowly shifting the sufferer's perceptions so that the fear and anxiety becomes irrational to them.
Neurolinguistic Programming (or NLP)
NLP is a newer field of treatment for a whole range of conditions including anxiety. It sounds like it might be "brain -washing" and in a sense it is.
The principal of NLP is that everything we do is because of learned behaviours. We exhibit patterns of behaviour because of patterns of thought which have built up often in early childhood.
These patterns of thought are like programmes which run over and over. So the idea is to re-programme the brain with new patterns of thought which will lead to new behaviours.
An example of this would be replacing negative thoughts about being overweight with the positive thoughts about the benefits of being slim and fit. It is a shifting of focus. Results have in some cases been remarkable in very little time.
What about Medication ?
Drugs used to help with anxiety are called anxiolytics.
It is important to remember that drugs used to help with anxiety will be treating the symptoms, physical and/or mental and not the cause.
They can be useful for an immediate control of symptoms so that other strategies can be started such as therapy or counselling etc. However, if the symptoms are suppressed then some therapies may be less effective.
The main drug groups used for anxiety are the Benzodiazepines some antidepressants and some Beta-blockers.
These drugs can be useful in anxiety states as they work quickly to reduce agitation and anxiety.
The drugs in this group have many side effects but the main one is drowsiness. There are more sedative versions which might be useful in those who find difficulty in getting to sleep or staying asleep. One major problem with this group is that they can be addictive particularly so in patients who abuse alcohol or drugs.
For this reason prescribing of these drugs is closely monitored by the doctor and the smallest dose is used for the shortest time.
Examples include Diazepam, Lorazepam, Oxazepam, Nitrazepam, Loprazolam and Temazepam. (The last three being particularly sedative) When these drugs are prescribed for longer times, they cannot just simply be stopped or the patient will suffer a withdrawal.
Buspirone is an interesting benzodiazepine which is thought to act at specific receptors in the brain called serotonin receptors. Response to treatment may take up to two weeks. It has low addiction rates but is only licensed for short periods but specialists occasionally use it for several months.
This class of drugs is an older group of drugs which has a long history of use in depression.
A few drugs in this group such as Imipramine and Amitriptyline are used in anxiety and panic disorders.
Drugs in this group are used when symptoms are severe and are prescribed for longer than the Benzodiazepines.
The main side effects of this group of medicines are drowsiness, blurred vision and dry mouth. Like the Benzodiazepines, they shouldn't be stopped quickly.
Selective Serotonin Reuptake Inhibitors (SSRIs) (Antidepressants)
SSRIs cause less drowsiness (although drowsiness is one of the most common side effects) than the Benzodiazepines or the Tricyclics. Side effects tend to be dose related and the main ones are drowsiness and upset stomach.
Very often when starting this class of drugs, the patient can feel worse before they feel better. It is very common to experience the side effects first and the benefits may not kick in until up to eight weeks after starting therapy although most people show a response somewhere around two weeks into therapy.
Some people may feel drastically worse and very depressed which might include feeling suicidal. However, because of the relatively gentler side effect profile this class of medication (which is also used for depression) has become the drug class of choice for anxiety and panic disorder.
The Beta-blocker group of drugs are primarily used to treat high blood pressure by blocking the receptors (called Beta receptors) that body chemicals like adrenaline act on.
Adrenaline and Noradrenaline when released in the body amp us up; we get excited, our heart rate and blood pressure increases and breathing rate increases.
This is the state that we get in when we are anxious or panicky. So the Beta-blockers dampen this process.
So you can see how they are very useful for helping to control high blood pressure although this class of medicines is being replaced with newer medicines for controlling high blood pressure.
Nevertheless, some members of this group - the main one being Propanolol is still used to control the physical effects of anxiety and panic.
These drugs of course have no effect on the underlying condition but they work quickly and so are useful in a number of cases.
Propanolol is used in small doses 10mg for example three or four times daily. By keeping the dose small, the main physical symptoms of anxiety and panic can be controlled to a degree without causing problems like for example lowering the blood pressure too much. Asthmatics should not take these drugs. They are not addictive.
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