Chronic Anxiety

“I just want to get rid of this anxiety!” is an all-too-common request heard by mental health professionals these days. Often, statements such as “I worry all the time, about everything. I can’t stop, it’s controlling my life,” follow as contributions to the anguished testimonials of patients, whose distressed facial expressions and tense body postures reflect the mental and physical exhaustion brought on by chronic anxiety.

In such cases, a clinical interview and assessment may support the diagnosis of an anxiety disorder, the most common mental health disorder in the United States. According to the National Institute of Mental Health, anxiety disorders have a prevalence rate of 18.1 percent among adults. More frequently diagnosed in women than men and often accompanied by symptoms of depression, this group of disorders includes social anxiety disorder, specific phobias, generalized anxiety disorder, panic disorder, obsessive-compulsive disorder, agoraphobia, and separation anxiety disorder. To be diagnosed with an anxiety disorder, symptoms generally have to persist for at least six months and involve excessive anxiety responses, leading to maladaptive behavioral patterns.

The term “disorder” rightfully calls for a cure. Wanting to “get rid of anxiety” seems a justifiable request, which renders its impossibility often intuitively difficult to accept—at least at first glance.

Anxiety as Part of the Human Experience

Anxiety is one of our most basic, emotional reactions and a part of the human experience.

Our ability to feel anxious serves an essential, adaptive function: survival and protection from harm. It is the feeling that follows our perception of a threat in the environment and, therefore, integral to our body’s alarm response. Controlled by our brain’s limbic system, anxiety comes on quickly and often without explanation. Given the limbic system’s developmental primacy over our frontal lobes, the seat of executive and higher order functioning, its authority is not easily questioned. We tend to trust in our feelings because we believe them to be true. We know it in our gut. They just feel right.

As human beings, our ability to identify threats and mobilize our physical resources to protect ourselves from harm is what has kept our species alive. When faced with a threat, our body mobilizes its physical resources and triggers an urgent binary choice. Propelled by a cascade of hormones, such as adrenaline and cortisol, which cause an increase in heart rate, body temperature and an overall sense of alarm and anxiety, we either face the threat and fight, or escape to avoid the situation.

Malfunctioning Threat Detection Systems

Anxiety, then, is the emotional byproduct of our body’s threat detection system and an important survival tool.  Yet, how is it possible that something intended to keep us safe has turned into a public health issue, causing significant distress and affecting the wellbeing of over 50 million Americans? How did an adaptive process lead to maladaptive behavioral patterns we so desperately try to eradicate from our lives? Complex neurochemical and epigenetic processes notwithstanding, individuals suffering from anxiety disorders have malfunctioning threat detection systems.

To function properly, our threat detection system must have two essential features: it must be able to do a valid harm assessment and it must know when to shut itself off. In other words, a well-functioning threat detection system engages its alarm response when faced with a real threat and ensures a time-limited activation of physical resources aimed at harm reduction.

Malfunctioning threat detection systems lack either one or both of these essential functions. If the first function fails, the threat detection system has lost the ability to distinguish between actual and possible threats. The system is working overtime, causing one to feel unsafe and constantly on alert. If the second function fails, the system, once activated, does not turn itself off, leading to prolonged and seemingly endless states of chronic anxiety. If both functions of the threat detection system malfunction, individuals, over time, avoid more and more situations, fearing their anxiety will become uncontrollable. An ever-widening net of behavioral restrictions follows suit with an increasing sense of loss of control over one’s life and emotions.

Researchers have been studying why one of the most basic human experiences can cause such distress and have started to identify factors leading to threat detection system malfunction. More specifically, studies show that exposure to adverse life events during early development, trauma, and prolonged stressful experiences can lead to changes in how we respond to threats from our environment and heighten, sensitize, overgeneralize and prolong our emotional reactions. Lack of consistent and reliable social support structures can also contribute to chronic anxiety.

Chronic Anxiety Treatment Options

When evaluating treatment options, severity of symptoms and their impact on daily life should be considered. First, it is important to mention that anxiety disorders are very treatable and that several treatment options are available. Given the range of symptom severity, individuals experiencing mild symptoms may get better on their own or with help from community support groups. A wide variety of psycho-educational literature and self-help workbooks are also available from experts in the field. For individuals experiencing more severe symptoms, the choice of treatment depends on whether the desired outcome is a long-term solution or short-term symptom relief. Weighing the benefits and risks of pharmacological treatment is also advisable.

Chronic Anxiety Pharmacological Treatment

Of the 18.1 percent US citizens suffering from anxiety disorders, 22.8 percent can be classified as experiencing “severe” symptoms, indicating a higher level of interference in daily life functioning. In regards to pharmacological treatment options, antidepressants, such as selective serotonin reuptake inhibitors (SSRIs) and other forms of antidepressants, such as selective noradrenaline reuptake inhibitors (SNRIs), as well as tricyclic antidepressants have shown to reduce symptoms of anxiety. Such medications should be prescribed under the care of a psychiatrist. Benzodiazepines, such as alprazolam, lorazepam and clonazepam have also been shown efficacious for temporary symptom-relief. As with any psychotropic medications, care should be taken regarding possible adverse and side effects. The addictive potential of benzodiazepines calls for thorough monitoring and risk assessment. Patients should also be educated about the potential of symptom recurrence following medication discontinuation.

Chronic Anxiety Psychotherapy

Targeted psychotherapeutic approaches have shown to be effective in the long-term reduction of anxiety symptoms. One form of therapy using an exposure-based approach focuses on “re-setting” the threat detection system by teaching individuals how to become more aware of their body’s alarm response, by learning how to correctly label “false alarms.” Over time, individuals learn to counteract the urge to avoid previously anxiety-provoking situations through a process called systematic desensitization. Increasing coping skills to address worry thoughts and practicing relaxation techniques, in the form of breathing exercises or mindfulness meditation, are also useful tools for the management of anxiety symptoms.

Chronic Anxiety Positive Psychotherapy

More recently, psychotherapeutic approaches have started to embrace a more comprehensive strength-based approach. Research in positive psychology informs treatment in important ways by offering a shift in focus from mere symptom relief towards growth and flourishing. Studies investigating the impact of positivity, authentic engagement, meaning and purpose, as well as the value and effect of positive relationships and accomplishments on individuals’ well-being lend support for the integration of positive psychology techniques. Within this framework, we do not seek to eradicate anxiety from our experience, but rather identify its strength-bearing qualities that help motivate and inspire us to move towards new experiences and opportunities.

Summary

When dealing with chronic anxiety, identifying the approach that best works for you, might be the most important factor. Taking your time to find the right course of action can go a long way towards ensuring successful treatment outcomes. When doing so, keeping the following in mind can be helpful:

• Don’t supersize your treatment approach
  While pharmacological treatment options are available and can lead to symptom relief, they may not be right for everyone. Moreover, medication alone, or even in combination with psychotherapy, may not lead to better or faster results. Research shows that relapse rates can actually be lower after a round of exposure-based therapy than after medication treatment. As a rule of thumb, consult with an expert, or two, or three, and consider choosing the least invasive approach, if symptoms are not too severe.
• Let your strengths be your guide
  Stop viewing anxiety as your enemy and begin to identify the strengths it affords you.  Admittedly, it may have gone into overdrive, but with the help of a trained therapist, you can learn how to regain control and re-set your threat detection system.  Increasing your awareness and insight can unlock new opportunities for growth and lead to a shift from hyper-threat- detection-mode to feeling more connected with yourself and others.
• Move your body, calm your mind
  Not enough can be said about the positive effects of exercise. So just get out there and move. In consultation and collaboration with your physician or therapist, set some goals for yourself and follow through on achieving them. Step by step, your mind will reap the benefits and your body will, too. Remember, you have the tools to activate your physical resources in various ways. Learn to use them to your advantage!