Anxiety is a common experience that is difficult to define. The diagnosis of an anxiety disorder may come as a surprise, because the symptoms are often attributed to a different source. Symptoms of anxiety overlap with many physical disorders, such that the etiology of the symptoms is apt to be confusing. Anxiety overwhelms conscious thought, decreasing the brain’s overall processing power. The more the symptoms are willed to subside, the more the symptoms appear to increase. Symptoms of anxiety may be ignored with willful effort, but never willed to go away. Anxiety is often an unwelcome guest that cannot be forced to leave.
What underlies the most common form of anxiety is fear. People are loath to admit a fear of nearly anything, which often allows the anxiety to tighten its grip. People want to imitate the cool control of the action hero. They want others to regard them as cool and in control. Their judgments about themselves and others reflect this cultural value, instilled by TV and the movies. One will never see the action hero cringing in the face of their enemy-paralyzed with fright. The reality is that fear is a primal emotion that shatters the illusion of control. It not only infects humans, but may be witnessed on the faces of all mammals. It is the emotion experienced before fighting or fleeing. It erases the past and future in an instant to focus on the present predicament. It is as necessary to survival as food and water.
Fear and aggression are flavors of avoidance and approach. We withdraw from objects we fear and towards those we want to destroy. Constant flight leads to starvation and constant aggression leads to a violent death. The choice of how and when to fight or flee is the key to remaining on top of the food chain. A person who is constantly aggressive would be labelled as foolish, not brave. A person who consistently flees from conflict would be labelled as a coward, not judicious. A wise person listens and learns from their fears. It is the voice of self-preservation. It’s the voice of the survival instinct. Anxiety is a necessary part of life.
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Pathological anxiety is to maintain a state of anxious/fearful apprehension, even though the threat is far removed. Anxiety is no longer adaptive in this situation, and may cause behavioral paralysis. It is rare for people to pull back at this point; to realize the generalized nature of their fear. Medication may reduce tension sufficiently to increase psychotherapy gains, but it is not recommended as the sole intervention. The patient will quickly depend on medication to allow daily functioning, but rarely understand the fear sufficiently to master the anxiety. Psychotherapy without medication is often successful for those with mild anxiety. Moderate to severe anxiety sufferers may be too anxious to make an appointment, or too tense to ingest the therapist’s words. As with the treatment of depression, a combination of psychotherapy and medication appears to be most successful.
The first task to rule out anxiety is consulting with a physician regarding the physical symptoms. Radiating numbness and tingling in the arms may be an early sign of a heart attack. Constant GI distress may be diverticulitis. As mentioned, anxiety has many physical manifestations that may lead the patient and clinician astray. Once the physical causes are believed to be benign, the second task is to make an appointment with the psychologist. This may be the most anxiety provoking task of all. Take heart. The determination to seek professional guidance is the first therapeutic intervention.
The following article completes a condensation of a literature review by Dr. Roger Walsh. The review appeared recently in the American Psychologist, a journal of the American Psychological Association. Dr. Walsh offered numerous Therapeutic Lifestyle Changes (TLC), based upon his examination of medical and psychological literature. It is hoped that these scientifically derived principles for living may benefit those suffering from cognitive and emotional impairments.
Dr. Walsh’s fourth area of consideration was the role of nature as a mediator of mental health. The psychological cost of indoor living includes disruption of mood, sleep and diurnal rhythms. Cognitive costs of indoor living include impairment of attention, decreased academic performance in the young and a greater cognitive decline in the elderly. Dr. Walsh did report that natural settings reduce stress and depression, but the amount of time spent outdoors to secure this benefit was lacking. Most of the studies he examined appeared to focus on poets and philosophers, such that scientific rigor was minimal. In a normal population, natural settings may enhance cognition, attention, and subjective well-being.
The role of relationships in all social animals is very important. A strong social attachment to a psychologist is more important than the school of therapy that is utilized. Said another way, what the therapist says is less important than their bond with the patient. Good relationships are associated with happiness, resilience, and cognitive capacity. The health risks of social isolation are believed to be comparable to risks of high blood pressure, smoking and obesity. Similar to the section on “Nature,” Dr. Walsh’s analysis of the literature did not include any guidelines for what defines a satisfying relationship, how many are sufficient, and the frequency which one must engage in good relationships to be therapeutic.
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Spiritual involvement may be an important mediator of mental and physical health. It appears to be most beneficial when centered on themes of love and forgiveness. Themes of guilt and punishment are less likely to be helpful to one’s mental health. Those who attend religious services at least weekly live about seven years longer than those who do not attend. Those who experience a rich spiritual life have reduced rates of mental disorders; such as anxiety, depression, substance abuse and suicide. The only significant link between spirituality and physical health is a reduced incidence of hypertension. A common criticism of this area of research is that the sample of people who attend church are less likely to smoke, drink and abuse drugs. Since their lifestyle is inherently different, it would need to be compared to spiritual people who indulged in these common vices.
In the concluding section of the literature review, Dr. Walsh discussed the so-called paradox of happiness. The nature of the paradox is that spending time helping others may accentuate one’s personal happiness. A major exception to this category is caretaker burnout. When family members take care of a demented spouse or parent, the sense of internal pressure and obligation may negate the positive affects of contributing to others. There is considerable research to link selfless behavior (altruism) with psychological, physical and social well-being. In some cases, providing social support may actually be more beneficial than receiving the help.
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February 10, 2012 10:05 am | 
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