Ten Steps to Relieve Anxiety. H. Michael Zal

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СКАЧАТЬ that has a genetic vulnerability and runs in families. At times of stress, it can escalate. Dr. Zal explains many of the common personality traits that anxious people often have, and I particularly like his concept of seeking contentment and not just happiness. He shows us that anxiety and worry can be handled and reduced, and he teaches his anxious clients which approaches are best for them to decrease their anxiety and become more functional and productive in their lives.

      I have known Dr. Zal since the late 1970s, and over a period of ten years we conducted joint research in the pharmacological treatment of anxiety and depression. I have followed his professional career ever since. Dr. Zal has published three prior books in the field of mental health, including Panic Disorder: The Great Pretender. Dr. Zal has assumed leadership roles in Philadelphia psychiatry, is a much respected lecturer, medical writer and editor on mental health topics and, most importantly, is one of the most outstanding clinicians I have ever known.

       —Karl Rickels, MD

       Stuart and Emily B. H. Mudd Professor of Psychiatry, University of Pennsylvania Founder, University of Pennsylvania Private Practice Research Group

Introduction

      Forty million adults suffer from anxiety disorders in the United States today. Of this, 6.8 million people have generalized anxiety disorder (GAD), which is our most common mental health problem. GAD is an inherited biological illness that may run in families. It is second only to major depressive disorder in lifetime frequency. Chronic anxiety can be demoralizing, limit your life and interfere with your ability to function. It may grow worse when you are under stress. Its clinical manifestations have great social, medical and economic consequences (most of the costs result from reduced or lost productivity).

      Søren Kierkegaard, the founder of existentialism, first described anxiety in his 1844 book, The Concept of Anxiety. He believed that the freedom to choose without guarantees about the correct choice caused dread and anxiety.¹ His colleagues Karl Jaspers, Martin Heidegger and Jean-Paul Sartre also agreed that man’s freedom to make choices is the source of his anxiety.² Jacob Mendes Da Costa noted the frequent association between chest pain and anxiety in soldiers who were upset by their experiences in the American Civil War.³ His article, “On Irritable Heart…,” published in 1871 in the American Journal of Medical Sciences, highlighted this connection. During the next hundred years, anxiety had a number of aliases, underlying the cardiac manifestations of anxiety. These labels changed after each major war. Cardiac Neurosis (Da Costa’s Syndrome) became “neurasthenia” during World War I. World War II brought the term “anxiety state.”

      Sigmund Freud stripped away the emphasis on physical symptoms to lay bare a theoretical skeleton emphasizing emotional components. He saw anxiety as one of the keys to understanding human dynamics and coined the phrase “anxiety neurosis.”⁴ Psychoanalysis sees anxiety as a signal that certain unacceptable impulses (sexual or aggressive feelings) are trying to escape the unconscious and are trying to break into consciousness. Mental pain serves as a signal to mobilize other defense mechanisms to try and keep this material out of awareness. These unacceptable urges can be real or symbolic.⁵

      A more modern view concentrates on the biological causes of anxiety. It involves three neurotransmitters, or hormone substances, that cause a nerve impulse to move from one nerve cell to another. They are gammaaminobutyric acid (GABA), serotonin and norepinephrine. Particular emphasis is placed on the GABA system not working properly. GABA acts as an internally produced tranquilizer that decreases anxiety. People with GAD may have low levels of this naturally produced hormone.

      Positron emission tomography (PET scan), which examines chemical changes in brain tissue, has shown that the neurotransmitters serotonin and norepinephrine also play a role in anxiety regulation. The discovery that these three hormones, or neurotransmitter systems, are involved in anxiety disorders allows us to recognize them as real biological conditions and true medical illnesses.

      Anxiety is a universal feeling. To a moderate degree, anxiety has various positive aspects and can be considered “normal.” It can serve as a biological warning system that is activated during times of potential danger or threat. It can prepare a person for an exam, speech or battle. It can increase alertness and effort and enhance your performance. It is the rapid beating of your heart as you await big news. It is the restless tension that you feel prior to taking a test or giving a business presentation. It is the worry that a parent experiences listening for a teenager to return home after their first solo car drive. It is the feeling of impending doom inherent in answering the boss’s call. It can be conducive to learning and growth.

      If these feelings become free-floating and increase in frequency and intensity, you have crossed the line from “normal” to “abnormal” anxiety. “Abnormal,” or nonadaptive, anxiety is more severe, interferes with functioning and with your capacity to experience satisfaction or pleasure. These more persistent levels of anxiety can cause disorganization, impair concentration, create uncomfortable physical symptoms, disturb sleep and precipitate depression and fatigue.

      At our first meeting I usually recognize anxiety clients because very often they come early for their appointments. Once they are seated in the treatment room, their tension flows across my desk in waves. By the end of the session, I am feeling their stress.

      “Have you generally been nervous all of your adult life?” is one of the key questions that I ask if I suspect that I am dealing with an anxious person and I want to quickly narrow the diagnostic field and rule in GAD. Besides free-floating anxiety, nervous people show three other cardinal features: avoidance behavior, excessive unrealistic worry and vague physical complaints. Anxious people often also complain of fatigue, headache, insomnia and abdominal or chest pain. The degree of disability may vary. The course is chronic and variable. Symptoms often intensify during times of stress.

       THE TRIAD OF ANXIETY

      The three features shown above, along with free-floating anxiety, are the cardinal characteristics of GAD. It is the most common of the anxiety disorders. To be diagnosed with this problem you must suffer from excessive anxiety and worry for at least six months in reference to a number of issues. The worry is difficult to control. The symptoms cause significant distress or impairment of functioning. The complaints are not due to the use of a substance, medical condition or other psychiatric disorder. You must show at least three other emotional or physical signs and symptoms of anxiety. These symptoms often result in significant emotional pain and prevent you from relaxing and enjoying life. Your anxiety can show in many ways:

       Emotional Aspects of Anxiety

      Feeling tense, keyed up or restless

      Irritability

      Apprehension

      Excessive worrying

      Feeling suddenly scared for no reason

      Fear of heights, darkness or being alone

      Social fears

      Sexual worries

      Fear of death or having a serious disease

      Feeling panicky

      Derealization (out of body experience)

      Fear of losing control or going crazy

      Feeling that something terrible СКАЧАТЬ