Life seems to be full of things that can trigger stress these days. Many people are concerned about financial or job security or their health or that of a love one.
In addition to everyday life stresses, people sometimes become anxious in social situations (social anxiety disorder); in response to specific situations or triggers, such as flying, animals (snakes and spiders), needles, or enclosed spaces (specific phobia); due to intrusive and unwanted thoughts (obsessive compulsive disorder); or even in response to their own bodily sensations (panic disorder).
The most common signs and symptoms of worry include restlessness and feeling jittery, difficulty concentrating, trouble sleeping, a racing mind, muscle tension, and an upset stomach.
Anxiety vs. panic attack
Everyone experiences anxiety occasionally, and in many ways this is a normal, healthy response to stress and challenges, says Nicholas Sibrava, PhD, of Butler Hospital and assistant professor (research), The Warren Alpert Medical School of Brown University.
Sometimes, however, anxiety can become extreme and begin to feel uncontrollable. "You may be unable to relax or focus on anything but your worries," explains Christina Boisseau, PhD, Butler Hospital and assistant professor (research), Alpert Medical School.
Many people misuse the term "panic attack" to describe this anxiety and worry. "A true panic attack is a very scary experience in which people feel overcome by fear and a sense of terror," Dr. Sibrava says. "Symptoms peak very quickly and very intensely." These include shortness of breath, dizziness, chest pain, sweating, feeling like your heart is pounding, tingling or numbness in your hands and feet, and a sense you will lose control, go crazy, or die.
Many people having a panic attack actually go to the emergency room worried that something serious is wrong. "Fortunately, although panic attacks are frightening, they are not a sign of something more serious like a heart condition. There are very effective psychosocial treatments that can help people reduce or eliminate panic attacks," Dr. Boisseau says.
When to seek care
"When anxiety starts to cause great distress, interferes with your ability to lead your life, prevents you from concentrating on work and home responsibilities, or prevents you from engaging in activities that you normally enjoy, it may be time to get help," Dr. Sibrava advises.
One of the most effective treatments is cognitive-behavioral therapy (CBT). "CBT teaches patients how to challenge and overcome anxious thoughts and guides them through exercises to help them confront the things that make them anxious," Dr. Boisseau says. The skills you learn in CBT can help you manage anxiety. In addition to CBT, acceptance and mindfulness-based approaches are also effective treatments.
A few different medications can also help, including antidepressants (Prozac, Paxil), which have also been shown to reduce anxiety and depression, or short-acting drugs to reduce the physical symptoms of anxiety (Benzodiazepines; Xanax, Ativan). "We don't generally recommend benzodiazepines as a long-term treatment solution because of their side effects, high potential for dependence, and perhaps most importantly, because they do not help you learn skills to manage anxiety, as you would learn in CBT," Dr. Sibrava says.
New alternatives
Recently, researchers have started to investigate new technologies such as smartphone-assisted interventions and mobile health apps to help people manage anxiety. "Smartphone-assisted interventions may help us to better tailor our treatments to individual patients, improve patient adherence to treatment, and help therapists monitor patient progress," Dr. Boisseau says.
Butler and Brown are also at the forefront of neurostimulation research using transcranial magnetic stimulation (TMS) and transcranial direct-current stimulation (tDCS). These use a focused magnetic field (TMS) or mild electric current (tDCS) focused on specific regions of the brain to temporarily alter activity in that area. Both techniques are painless, non-invasive outpatient procedures shown to help with symptoms of anxiety and depression.
"We hope these treatments will provide additional benefits to patients and complement current treatments like CBT," Dr. Sibrava notes.
-Karen Appold
