ANXIETY

Overview
What is Anxiety? What are the different types of anxiety disorders? What are the causes? What are the symptoms? What are the treatments? Professional Resources available.

Definition of Anxiety
Anxiety is a feeling of apprehension or fear. The source of this uneasiness is not always known or recognized, which can add to the distress you feel. Anxiety disorders are a group of psychiatric conditions that involve excessive anxiety.

Types of Anxiety Disorders

Panic Disorder Obsessive-Compulsive Disorder Post-Traumatic Stress Disorder Phobias Generalized Anxiety Disorder

Panic Disorder
Episode rasa takut yang sangat atau tidak nyaman, puncaknya 10 menit, terdapat 4 minimal gejala :

Merasa ada bahaya mengancam

Ingin malarikan diri Palpitations keringat berlebih gemetaran Sesak napas Ada rasa seperti tersedak Nyeri dada

mual atau perut tidak nyaman Pusing Merasakan tidak sesuai kenyataan Takut kehilangan tau merasa gila Takut mati Kesemutan Menggigil

Panik
There are three types of Panic Attacks:
1. Tak Terduga serangan tibatiba tanpa ada alasan. 2. Situational situasi dimana seorang individu selalu merasa ada serangan 3. Situationally Predisposed - situations in which an individual is likely to have a Panic Attack, but does not always have one. An example of this would be an individual who sometimes has attacks while driving.

Obsessive-Compulsive Disorder
Ditandai dengan obsesi atau dorongan yang tidak terkendali, penderita biasanya mengakui sebgai sesuatu yang berlebihan atau tidak masuk akal: Obsesi adalah pikiran yang berulang atau impuls yang menganggu atau tidak sesuai.
Pikiran takut terkontaminasi Keragu-raguan yang terus menerus Keteraturan yang berlebihan Adanya impuls agresif

Obsessive-Compulsive Disorder
Compulsions adalah perilaku berulang atau ritual yang dilakukan penderita
Membersihkan. Berulang kali cuci tangan, mandi Memeriksa Mengulang. Mengulang nama, frase Kelambatan. Menimbun barang yang tidak berguna

Post-Traumatic Stress Disorder

Paparan trauma seperti kecelakaan, bencana alam, suasana kriminal.
Gejla :
Mengingat kejadian Perilaku menghindar Kehilangan minat Hipersensitivitas

Social Phobia/Anxiety
Gangguan kecemasan sosial adalah ketakutan berlebih dalam situasi sosial. Muncul ketika individu percaya bahwa mereka dinilai, diteliti tau dipermalukan orang lain
Individu dengan gangguan tersebut sadar tanda-tanda fisik dari kecemasan dan ketakutan bahwa orang lain akan melihat, menghakimi dan berpikir buruk dari mereka Dalam kasus yang ekstrim : intensitas kegelisan bisa beranjak ke serangan panik sampai terjadi sesak napas

Social Phobia/Anxiety
Sering terjadi karena:
Pembicaraan masyarakat Berbicara dengan orang dalam otoritas Saat mengembangkan hubungan yang erat Saat menelpon atau menjawab telepon Wawancara Berada dalam kelas Berbicara dengan orang asing Bertemu orang baru Makan minum di depan umum

Generalized Anxiety Disorder

Khawatir yang tak terkendali tentang hal sehari-hari. Menyebabkan fungsi sehari-hari dan menyebabkan gangguan fisik
GAD can occur with other anxiety disorders, depressive disorders, or substance abuse.

Generalized Anxiety Disorder

The focus of GAD worry can shift, usually focusing on issues like job, finances, health of both self and family; but it can also include more mundane issues such as, chores, car repairs and being late for appointments. The intensity, duration and frequency of the worry are disproportionate to the issue

Specific Disorder Facts

Generalized Anxiety Disorder
Women are twice as likely to be afflicted than men. Very likely to exist along with other disorders.

Obsessive Compulsive Disorder

It is equally common among men and women. One third of afflicted adults had their first symptoms in childhood.

Panic Disorder
Women are twice as likely to be afflicted than men. Occurs with major depression in very high rates.

2003 Anxiety Disorders Association of America

Specific Disorder Facts

Posttraumatic Stress Disorder
Women are more likely to be afflicted than men. Rape is the most likely trigger of PTSD, 65% of men and 45.9% of women who are raped will develop the disorder. Childhood sexual abuse is a strong predictor of lifetime likelihood for developing PTSD.

Social Anxiety Disorder

It is equally common among men and women.

Specific Phobia affects

Women are twice as likely to be afflicted as men

2003 Anxiety Disorders Association of America

Anxiety Statistics
Anxiety Disorders One-Year Prevalence (Adults)
Percent Population Estimate* (Millions)

Any Anxiety Disorder

Panic Disorder Obsessive-Compulsive Disorder Post-Traumatic Stress Disorder Any Phobia Generalized Anxiety Disorder

13.3
1.7 2.3 3.6 8.0 2.8

19.1
2.4 3.3 5.2 11.5 4.0

* Based on 7/1/98 U.S. Census resident population estimate of 143.3 million, age 18-54

Common Causes
There is no one cause for anxiety disorders. Several factors can play a role
Genetics Brain biochemistry Overactive "fight or flight" response Can be caused by too much stress Life circumstances Personality
People who have low self-esteem and poor coping skills may be more prone

Certain drugs, both recreational and medicinal, can lead to symptoms of anxiety due to either side effects or withdrawal from the drug. In very rare cases, a tumor of the adrenal gland (pheochromocytoma) may be the cause of anxiety.

Symptoms of Anxiety
Anxiety is an emotion often accompanied by various physical symptoms, including:
Twitching or trembling Muscle tension Headaches Sweating Dry mouth Difficulty swallowing Abdominal pain (may be the only symptom of stress especially in a child)

Additional Symptoms of Anxiety

Sometimes other symptoms accompany anxiety:
Dizziness Rapid or irregular heart rate Rapid breathing Diarrhea or frequent need to urinate Fatigue Irritability, including loss of your temper Sleeping difficulties and nightmares Decreased concentration Sexual problems

Physical Reaction to Anxiety

Auditory and Visual Stimuli: sights and sounds are processed first by the thalamus, which filters the incoming cues and shunts them either directly to the amygdala or to the other parts of the cortex. Olfactory and tactile stimuli: Smells and touch sensations Bypass the thalamus altogether, Taking a shortcut directly to the Amygdala. Smells, therefore, Often evoke stronger memories Or feelings than do sights or Sounds.

Physical Reaction to Anxiety

Thalamus: The hub for sights and sounds, The thalamus breaks down Incoming visual ques by size, Shape and color, and auditory Cues, by volume and Dissonance, and then signals The appropriate part of the Cortex. Cortex: It gives raw sights and sounds meanings, enabling the brain to become conscious of what it Is seeing or hearing. One region, the prefrontal cortex, may be vital to turning off the anxiety response once a threat has passed.

Physical Reaction to Anxiety

Amygdala: emotional core of the brain, the amygdala has the primary role of triggering the fear response. information that passes through the amygdala is tagged with emotional significance. Bed Nucleus of Stria Terminalis: unlike the Amygdala, which sets off an immediate burst of fear, the BNST perpetuates the fear response, causing the longer term unease typical of anxiety.

Physical Reaction to Anxiety

Locus Ceruleus: It receives signals from the amygdala and is responsible for initiating many of the classic anxiety responses: rapid heartbeat, increased blood pressure, sweating and pupil dilation. Hippocampus: This is the memory center, vital to storing the raw information coming in from the senses along with the emotional baggage attached to the data during their trip through the amygdala.

Social Effects of Anxiety

Depression
Not as involved with family and friends the way you used to be Lowered quality of relationships Low energy Lack of motivation to do the things you once looked forward to doing

Unable to convey the person that you are Fear and avoidance of situations where previous attacks occurred

Allopathic Treatments
Medications (Drug Therapy): Behavioral Therapy Cognitive Behavioral Therapy Psychodynamic Psychotherapy

Alternative Treatments
Acupuncture Aromatherapy Breathing Exercises Exercise Meditation Nutrition and Diet Therapy Vitamins Self Love

Medications
Buspirone: shown to be effective but usually takes 34 weeks, particularly useful in elderly patients Benzodiazepines: include Xanax and Valium, act rapidly and successfully but can be addictive and loses effectiveness over time Side Effects: dizziness, headaches, nausea, impaired memory

Behavioral and Cognitive Therapy

Teaches patient to react differently to situations and bodily sensations that trigger anxiety Teaches patient to understand how thinking patterns that contribute to symptoms Patients learn that by changing how they perceive feelings of anxiety, the less likely they are to have them Examples: Hyperventilating, writing down list of top fears and doing one of them once a week, spinning in a chair until dizzy; after awhile patients learned to cope with the negative feelings associated with them and replace them with positive ones

Psychodynamic Psychotherapy
Psychodynamic therapy is a general name for therapeutic approaches which try to get the patient to bring to the surface their true feelings, so that they can experience them and understand them. Psychodynamic Psychotherapy uses the basic assumption that everyone has feelings held in the subconscious which are too painful to be faced. We then come up with defenses (such as denial) to protect us knowing about these painful feelings. Psychodynamic psychotherapy assumes that these defenses have gone wrong and are causing more harm than good, making you seek help. It tries to subdue them, with the intention that once you are aware of what is really going on in your mind the feelings will not be as painful. Takes an extremely long time and is labor intensive

Acupuncture
Caused by the imbalance of chi coming about by keeping emotions in for too long Emotion effects the chi to move in an abnormal way: when fearful it goes to the floor, when angry the neck and shoulders tighten Redirects the chi into a balanced flow, releases tension in the muscles, increases flow of blood, lymph, and nerve impulses to affected areas Takes 10-12 weekly sessions

Aromatherapy
Calming Effect: vanilla, orange blossom, rose, chamomile, and lavender Reducing Stress: Lavender, sandalwood, and nutmeg Uplifting Oils: Bergamot, geranium, juniper, and lavender Essential Oil Combination: 3 parts lavender, 2 parts bergamot, and 1 part sandalwood

Exercise
Benefits: symbolic meaning of the activity, the distraction from worries, mastery of a sport, effects on self image, biochemical and physiological changes associated with exercise, symbolic meaning of the sport Helps by expelling negative emotions and adrenaline out of your body in order to enter a more relaxed, calm state to deal with issues and conflicts

Meditation
Cultivates calmness to create a sense of control over life Practice: Sit quietly in a position comfortable to you and take a few deep breaths to relax your muscles, next choose a calming phrase (such as om or that with great significance to you), silently repeat the word or phrase for 20 minutes

Nutrition and Diet Therapy

Foods to Eat: whole grains, bananas, asparagus, garlic, brown rice, green and leafy veggies, soy products, yogurt Foods to Avoid: coffee, alcohol, sugar, strong spices, highly acidic foods, foods with white flour Keep a diary of the foods you eat and your anxiety attacks; after awhile you may be able to see a correlation East small, frequent meals

Vitamins
B-Vitamins stabilize the bodys lactate levels which cause anxiety attacks (B-6, B-1, B-3) Calcium (a natural tranquilizer) and magnesium relax the nervous system; taken in combination before bed improves sleep Vitamin C taken in large doses also has a tranquilizing effect Potassium helps with proper functioning of adrenal glands Zinc has a calming effect on the nervous system

Self Love
The most important holistic treatment of all Laugh: be able to laugh at yourself and with others; increases endorphin levels and decreases stress hormones Let go of frustrations Do not judge self harshly: dont expect more from yourself than you do others Accept your faults

Where to Get Help

SFSU Health Center - The services of the Center are open to regularly enrolled (matriculated) undergraduate and graduate students. Office hours are 8AM to Noon and 1PM to 7PM Monday through Thursday and until 5PM on Friday. Appointments may be made by phone (415) 338-2208 or in person at Student Services Building Room 208. Any licensed psychologist or psychiatrist U.S. Dept. of Health & Human Services Substance Abuse & Mental Health Services Administration find resources in your area http://www.mentalhealth.samhsa.gov/databases

Additional Links
Anxiety Screening Tools Anxiety Disorders Association of America (ADAA) Freedom From Fear (www.freedomrfomfear.org) National Institute of Mental Health (www.nimh.nihgov) U.S. Dept. of Health & Human Services (http://www.mentalhealth.samhsa.gov/topics/explor e/stress/)

The End