The Basics on Generalized Anxiety

BY DR. R. REID WILSON , REPRINTED WITH PERMISSION

This is one of a series of excellent articles on anxiety taken from Dr. Wilson's website, more information on which can be found at the bottom of this page.

Dr. Wilson, a specialist in treating panic attacks and generalized anxiety, describes the difference between them and how each are treated.

First, let's look further at the physical symptoms. Although the specific manifestations of anxiety vary for each person, this chronic state of tension can affect six major systems of the body.

In the cardiovascular system, anxiety increases blood pressure, which causes tachycardia (rapid heartbeat), constriction of the blood vessels in the arms and legs, and dilation of the vessels surrounding the skeletal muscles. These changes produce symptoms of palpitations (an uncomfortable awareness of the heart rate), headaches, and cold fingers.

In the gastrointestinal system, anxiety leads to reduced salivary secretions, spasms within the esophagus (the hollow muscular tube leading from the nose and mouth to the stomach), and alterations in the stomach, intestines, and anal sphincter. These systemic changes result in symptoms of dry mouth, difficulty swallowing, "butterflies" in the stomach, the gurgling sounds of gas in the intestines, and mucous colitis (an inflammation of the colon), causing spasms, diarrhea and/or constipation, and cramp-like pains in the upper stomach.

In the respiratory system, anxiety leads to hyperventilation, or overbreathing, which reduces the carbon dioxide in the blood, with symptoms of "air hunger," deep sighs, and pins-and-needles sensations.

In the genitourinary systems, the anxious person can experience the need for frequent urination. Men may have difficulty maintaining an erection during intercourse; women may have difficulty becoming sexually aroused or achieving orgasm.

In the musculoskeletal system, the muscles become tense. Involuntary trembling of the body, tension headaches, and other aches and pains may develop.

Through changes in the central nervous system, the anxious person is generally more apprehensive, aroused, and vigilant, feeling "on edge," impatient, or irritable. He may complain of poor concentration, insomnia, and fatigue.

Generalized Anxiety or Panic Attacks?

When someone complains about these symptoms, and if he has excessive worries, too, then he might be suffering from what we call generalized anxiety disorder. There is often a fine line between the diagnosis of panic disorder and that of generalized anxiety disorder. Three features distinguish them. First, the symptoms themselves: if an individual is chronically anxious (as he would be with generalized anxiety disorder) and also experiences episodes of panic, then panic disorder will be the more likely diagnosis.

The second distinction is the kind of fearful thoughts associated with the problem. Most people with generalized anxiety disorder will worry about the kinds of interactions they will have with others: "Will I fail in this work setting?" "Are they going to accept me?" "I'm afraid he's going to leave me." "What if they discover how little I know?" "I'll never perform up to their expectations."

With panic disorder, the imagined response of others is secondary to the fear of personal catastrophe or loss of control, and the person's internal statements and questions will reflect this apprehension: "What if I faint (become hysterical, have a heart attack, cause a scene . . .), and people see me?" The panic-prone person focuses more on his inability to be in 100 percent control of all his physical and mental capacities. The anxious person focuses more on his inability to cope with the expectations and responses of those around him.

The third difference has to do with the person's response to his fears. The anxious person thinks about withdrawing from situations that increase his anxiety, and may procrastinate on performance tasks. The person with panic disorder, on the other hand, is quick to use avoidance as a way to diminish discomfort. In a matter of days he will begin to identify the situations that are associated with the symptoms and determine how he can steer clear of them. With panic, he immediately views avoidance as the single best solution to the problem.

Treatment of Generalized Anxiety

Mental health professionals have developed a variety of treatment approaches that have proved successful against this disorder. These often include cognitive behavioral therapies that seek to alter the way that generalized anxiety sufferers think about and respond to troubling situations.

Some individuals report that they have regained control of their lives without medication or extensive psychological counseling by learning anxiety management techniques. Systematic tensing and relaxing of muscle groups, a technique known as progressive muscle relaxation, has helped a large percent of these sufferers. Some patients report that physical exercise programs, perhaps requiring no more than 30 minutes a day and no more strenuous than brisk walking, provide relief from generalized anxiety. Meditation, yoga, massage and biofeedback are other relaxation tools that may be beneficial for some people. Controlled breathing and refusing one's thoughts on the present may also reduce anxiety.
These techniques do not provide instant relief. As a rule, they take effect gradually, and they must be practiced regularly for lasting benefit.

Understanding their own thought processes and how they evaluate disturbing situations helps some people control their anxieties. Cognitive therapy is designed to reduce anxiety by giving individuals the skills to assess situations more realistically. Patients may be trained to identify anxious and unrealistic thoughts and develop techniques to change their responses. Cognitive therapy may be supported by instruction in altering behavior or by lifestyle changes designed to cut down on stress.

Medication has also proven effective in relieving anxiety symptoms, particularly in providing fast relief from acute anxiety, and allowing other therapy to go forward.

© Copyright 2003, reprinted with permission. Dr. R. Reid Wilson is a licensed psychologist specializing in the treatment of all anxiety disorders. He directs the Anxiety Disorders Treatment Program in North Carolina. Clinical Associate Professor of Psychiatry at the University of North Carolina School of Medicine, he is author of Don't Panic: Taking Control of Anxiety Attacks and is co-author of Stop Obsessing!: How to Overcome Your Obsessions and Compulsions (Revised Edition), and co-author of "Achieving Comfortable Flight", a self-help kit for the fearful flier. He designed, and served as lead psychologist for, American Airlines' first national program for the fearful flier. He holds a Ph.D. in Clinical Psychology, and his television appearances have included The Oprah Winfrey Show, Good Morning America, and America's Talking.

LEARNING TO TACKLE ANXIETY, FEAR AND SHAME

BY ARLENE HARDER, MA, MFT

Book review of Fear and Other Uninvited Guests, by Harriet Lerner, Ph.D., Harper-Collins Publisher

The author of this wonderful book about fear, anxiety and shame doesn't claim to give you "a new, seventeen-day plan to help you stop panicking." She does something even better.

With humor and grace she offers readers hope they can someday move out of the shadow of these potentially paralyzing emotions by discovering what they have to teach us. And you know this woman writes from the heart when she shares her fear of public speaking and how her model for living is her cat Felix.

As a therapist, a former client of several therapists, and a recovering perfectionist, I am personally aware of the difficulty of dealing with deep-seated shame. How I wish I had read this paragraph before I began therapy many decades ago.

"Good self-esteem rests, first and foremost, on having an objective, balanced perspective on our strengths and weaknesses. We all have plenty of both. But anxiety and fear push us to expremes, so we may feel like an emotional basket case on the one hand, or present ourselves as having no needs, problems, or loose ends on the other. Anxiety, by its very nature, will lead you to lose ojectivity about the complex, wonderful, flawed, ever-changing person you are. When you can't see yourself objectively, you won't see anyone else objectively, either."

When you read Fear and Other Uninvited Guests : Tackling the Anxiety, Fear, and Shame That Keep Us from Optimal Living and Loving, you will appreciate the author's observation that, "the process of self-observation, reflection, and change is basically a self-loving task. It will not flourish in an atmosphere of teminal seriousness, self-flagellation, or self-blame."