Ten Steps to Relieve Anxiety. H. Michael Zal

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       Physical Aspects of Anxiety

      CARDIOVASCULAR

      Palpitations

      Dizziness

      Faintness or lightheadedness

      Chest pain or pressure

      RESPIRATORY

      Shortness of breath

      Hyperventilation

      Choking sensation or lump in the throat

      MUSCULAR

      Muscle tension

      Easy fatigability

      Trembling/shaking

      Weakness

      Rubbery or “jelly legs”

      GASTROINTESTINAL

      Dry mouth

      Indigestion

      Nausea and vomiting

      Butterflies in stomach

      Diarrhea

      Flatulence

      OTHER

      Sweating/hot flashes or chills

      Headache

      Constant urge to urinate

      Numbness or tingling sensation

      Spells of increased sensitivity to sound, light or touch

      Difficulty in concentration/mind goes blank

      Sleep disturbance

      Exaggerated startle response

      Skin disorders

      Your physician or psychiatrist needs to rule out other emotional and physical disorders and rule in other overlapping, or comorbid, conditions. Individuals with a normal reaction to stress, major depression, personality disorders or those withdrawing from substance abuse or dependency can show anxiety. Anxiety can also be seen in acute psychosis and schizophrenia. People suffering from hyperthyroidism, hypertension, cardiac arrhythmias or mitral valve prolapse can all come in the door complaining of anxiety. Various medical disorders such as irritable bowel syndrome, asthma/chronic obstructive pulmonary disease (COPD) and pheochromocytoma, a hormone-producing tumor, can overlap with anxiety symptoms.

      Generalized anxiety disorder clients may also suffer from other anxiety disorders such as obsessive-compulsive disorder (OCD), social phobia, post-traumatic stress disorder (PTSD) and panic disorder. Your doctor initially needs to decide if your complaints are emotional, physical or both. To decide this, we need to take a good health history, check all of your medications, question you about drug use or abuse and look at basic bloodwork. I usually ask for at least a complete blood count (CBC and Differential), comprehensive metabolic panel and thyroid profile (thyroid stimulating hormone [TSH], T3, T4). Therapists often may have to talk to your current and previous physicians. If you are diabetic, we may need to follow your glucose and HbA1C numbers. Fluctuations in your sugar levels can affect your mood. At times, a testosterone level may be helpful in men to differentiate between low energy due to anxiety and physical issues. Being given a specific diagnosis can give relief and even reassurance to some people. As they exhale, they often say, “You mean that all I have is anxiety? I thought that I was going crazy.”

      Anxiety is possible throughout the life cycle. It can hide within shy, inhibited children and adolescents in crisis. It can appear in young adults expanding their social and vocational options and can accompany the shattered expectations of midlife. GAD may actually be the prevalent mental disorder in the elderly. It is sometimes difficult to diagnose in this age group. Their bodily complaints and sleep problems can signify anxiety. Depression, dementia and even substance abuse can mask and/or produce anxiety symptoms. Primary medical problems as well as medication can also cause their anxiety. Studies have shown that GAD (affecting 7 percent of seniors) is more common in the elderly than depression, which affects about 3 percent of seniors.⁶

      GAD is common, chronic and disabling. It is a real biological illness that is treatable. It is not a form of hypochondria or a sign of weakness. It usually presents with the four cardinal features noted earlier but can often present with physical complaints alone. Treatment options include education and reassurance, psychotherapy, cognitive-behavioral therapy (CBT), pharmacology, relaxation/meditation/biofeedback, exercise and diet. Spirituality is helpful to many. You must conquer the cycle of fear and reduce cognitive distortion. Thoughts such as “something terrible is going to happen” and “I am going to lose control” can escalate anxiety and fear. Try to interpret these feelings to simply mean “I am feeling nervous.”

      Managed care has marginalized many psychiatrists into just doing medication management. One of the biggest and most important changes during my long psychiatric career is the growth in the field of psychopharmacology and the benefits of psychiatric medication. However, there is no “magic pill” to solve all of your emotional problems. Psychiatric training is now moving toward a return to teaching residents and fellows to conduct therapy.

      This book was written from my vantage point as a clinician working with real people. I provide both therapy and medication management. I feel that they are both important in obtaining relief from emotional distress. I take an eclectic but old-fashioned approach and offer individualized treatment suggestions that put the emphasis on the whole person. I will discuss conventional as well as alternative therapies. Many options will be offered.

      Unlike many books that promise a cure, this one will present a more realistic picture of what treatment can accomplish for you. An appropriate expectation of psychiatric treatment is that it can offer education, reassurance, symptom reduction and control, teach coping mechanisms and ways to feel more in control, foster perspective and insight about the past and present and encourage growth and maturity. A positive therapist-client relationship is a strong therapeutic tool. A connection with your therapist can allow you to feel secure while you are learning to deal with your anxiety.

      Therapy can help you understand yourself better and often can give you the support, encouragement and acceptance that you did not receive when you were young. Your parents may not have been able to give you everything you wanted emotionally, because their own parents may have been limited. Therapy cannot totally make up for the things that you did not obtain in childhood. It cannot completely fill or reverse the void often left by earlier unfulfilled needs for love or nurturing. However, if we can get you to feel better about yourself, reinforce your gains and offer support when needed, it goes a long way toward balancing the deficit.

      However, psychiatric treatment cannot make you immune to anxiety. GAD is a chronic, lifelong condition that can wax and wane depending on your life stress. It is impossible to place a time limit on the appearance or disappearance of symptoms or when they will increase or decrease. The truth of the matter is that people who are anxious, even with good treatment, will not always be anxiety free. They can feel less anxious, feel anxious less often and be better able to cope with their nervousness when it does occur. But as I’ve said, anxiety is inherited: it is part of your DNA. Under certain circumstances and in certain situations, it may always pop up in your life. However, you can be less anxious more often and handle your anxiety better when it does arise. I will emphasize acceptance and proactive СКАЧАТЬ