is an unpleasant emotion characterized by a feeling of vague,
unspecified harm. Like FEAR, it can cause a state of physical
disturbance; unlike fear, it is characterized by the absence of an
apparent cause, the circumstance that precipitates anxiety is hidden and
unknown to the person. When the cause for anxiety becomes known but the
feeling of apprehension remains, it is called worry.
has many symptoms, most of which masquerade as genuine physical
ailments. Included are
rapid or pounding heartbeat, difficult breathing or breathlessness,
tremulousness, sweating, dry mouth, tightness in the chest, sweaty
palms, dizziness, weakness, nausea, diarrhea, cramps, insomnia, fatigue,
headache, loss of appetite, and sexual disturbances. In addition to the uncomfortable bodily sensations associated
with fear, anxiety results in a narrowing of one’s time perspective so
that only the present matters; it
also results in an inability to attend to more than one task at a time
or to organize thoughts and plans effectively.
Anxiety lowers one’s ability to perform most tasks.
Low levels of anxiety may temporarily increase a person’s
ability to do a simple task, due to the greater vigilance and narrowing
of one’s ATTENTION associated with anxiety, but as anxiety increases,
behavior becomes more disorganized and ineffective.
types of anxiety are recognized in psychoanalysis.
The first type, traumatic anxiety, results from over stimulation. Events happen faster than the mind can comprehend them;
this produces a feeling of crisis.
Sigmund FREUD believed that this feeling has a physical basis in
the capacity of the nervous system and that birth throws every child
into a state of traumatic anxiety.
In his view, this birth trauma becomes the model for later
episodes of anxiety.
second type of anxiety in psychoanalysis, signal anxiety, is believed to
arise from a person’s need to guard against the disorganization of
traumatic anxiety. The EGO
appraises its own ability to cope with both external demands and the
push of internal drives and wishes.
When normal methods of coping with these pressures threaten to
fail, the ego responds with anxiety, which then mobilizes the person to
take new action. The small-scale discomfort of signal anxiety helps to
avoid a larger, more devastating experience.
LEARNING THEORY, anxiety is seen both as a response to learned cues and
as a drive, or motivator, of behavior.
Most learning theorists maintain that anxiety is derived from
reaction to PAIN. Anxiety
can thus be reduced by removing or avoiding the source or sources of the
situations that have produced pain. Avoidance may become firmly established and lead to
constricted or bizarre behavior. A
better way to reduce anxiety is to pair a strong, positive reinforcer
such as food with the frightening situation so that the stimulus that
formerly elicited anxious responses becomes associated with positive
the control of anxiety, psychologists have recently focused on the role
of cognition as the origin of anxiety.
Cognitive theories emphasize the process of appraisal and the
often unnoticed internal dialogue that amplifies emotional response.
Experiments have shown that the interpretation of a situation
determines whether a person feels anxiety or some other emotion.
Learning to substitute benign reappraisals for unrealistically
negative “self-talk” reduces anxiety.
exists that some persons may be biochemically vulnerable to an extreme
form of anxiety known as “panic attacks.” Some medications relieve
the panic, leading to the hope that anxiety can be understood
physiologically, but the metabolic pathways are unknown and may be quite
complex. A combination of
medication and therapies, including relaxation training, provides the
best treatment for panic attacks.
OF ANXIETY DISORDERS
is a normal part of life. However,
when anxiety becomes frequent and excessive it may indicate the presence
of a clinically diagnosable anxiety disorder.
Those experiencing any of these symptoms may have an anxiety disorder:
Types of anxiety disorders include:
OF ANXIETY DISORDERS
people with anxiety disorders can be helped with treatment.
Therapy for anxiety disorders often involves medication or
specific forms of psychotherapy. Medications, although not cures, can be
very effective at relieving anxiety symptoms.
thanks to research by scientists at NIMH and other research
institutions, there are more medications available than ever before to
treat anxiety disorders. So
if one drug is not successful, there are usually others to try.
In addition, new medications to treat anxiety symptoms are under
development. For most of the medications that are prescribed to treat
anxiety disorders, the doctor usually starts the patient on a low dose
and gradually increases it to the full dose.
Every medication has side effects, but they usually become
tolerated or diminish with time. If side effects become a problem, the doctor may advise the
patient to stop taking the medication and to wait a week—or longer for
certain drugs—before trying another one.
When treatment is near an end, the doctor will taper the dosage
has also shown that behavioral therapy and cognitive-behavioral therapy
can be effective for treating several of the anxiety disorders.
Behavioral therapy focuses on changing specific actions and uses
several techniques to decrease or stop unwanted behavior.
For example, one technique trains patients in DIAPHRAGMATIC
BREATHING, a special breathing exercise involving slow, deep breaths to
reduce anxiety. This is
necessary because people who are anxious often hyperventilate, taking
rapid shallow breaths that can trigger rapid heartbeat, lightheadedness,
and other symptoms. Another technique—EXPOSURE THERAPY—gradually exposes
patients to what frightens them and helps them cope with their fears.
behavioral therapy, cognitive-behavioral therapy teaches patients to
react differently to the situations and bodily sensations that trigger
panic attacks and other anxiety symptoms.
However, patients also learn to understand how their thinking
patterns contribute to their symptoms and how to change their thoughts
so that symptoms are less likely to occur.
This awareness of thinking patterns is combined with exposure and
other behavioral techniques to help people confront their feared
situations. For example,
someone who becomes lightheaded during a panic attack and fears he is
going to die can be helped with the following approach used in
cognitive-behavioral therapy. The
therapist asks him to spin in a circle until he becomes dizzy.
When he becomes alarmed and starts thinking, “I’m going to
die,” he learns to replace that thought with a more appropriate one,
such as, “It’s just a little dizziness—I can handle it.”
TO GET HELP FOR ANXIETY DISORDERS
you, or someone you know, has symptoms of anxiety, a visit to the family
physician is usually the best place to start.
A physician can help you determine if the symptoms are due to an
anxiety disorder, some other medical condition, or both.
Most often, the next step to getting treatment for an anxiety
disorder is referral to a mental health professional. Among the
professionals who can help are psychiatrists, psychologists, social
workers, and counselors. However,
it’s best to look for a professional who has specialized training in
cognitive-behavioral or behavioral therapy and who is open to the use of
medications, should they be needed. Psychologists, social workers, and
counselors sometimes work closely with a psychiatrist or other
physician, who will prescribe medications when they are required. For some people, group therapy or self-help groups are a
helpful part of treatment.
people do best with a combination of these therapies. When you’re
looking for a health care professional, it’s important to inquire
about what kinds of therapy he or she generally uses or whether
medications are available. It’s
important that you feel comfortable with the therapy.
If this is not the case, seek help elsewhere.
However, if you’ve been taking medication, it’s important not
to quit certain drugs abruptly, but to taper them off under the
supervision of your physician. Be sure to ask your physician about how
to stop a medication.
though, that when you find a health care professional you’re satisfied
with, the two of you are working as a team.
Together you will be able to develop a plan to treat your anxiety
disorder that may involve medications, behavioral therapy, or
cognitive-behavioral therapy, as appropriate.
for anxiety disorders, however, may not start working instantly.
Your doctor or therapist may ask you to follow a specific
treatment plan for several weeks to determine whether it’s working.
continues its search for new and better treatments for people with
anxiety disorders. The Institute supports a sizeable and multifaceted research
program on anxiety disorders—their causes, diagnosis, treatment, and
prevention. This research
involves studies of anxiety disorders in human subjects and
investigations of the biological basis for anxiety and related phenomena
in animals. It is part of a
massive effort to overcome the major mental disorders, an effort that is
taking place during the 1990s, which Congress has designated the Decade
of the Brain.
INTERVENTION APPROACHES FOR CHILDREN WITH EXCESSIVE ANXIETY
When anxiety is shown to an unusual or severe degree, assistance should be given to the child. Possible steps that might be taken, after adequate diagnosis, include the following:
Beck, A. T., Cognitive Therapy and the Emotional Disorders
(1976); Berger, J. G., ed.,
Antianxiety Agents (1986);
Charles G., Anxiety and Depression (1976);
Dollard, John, and Miller, Neal, Personality and Psychotherapy
Sigmund, The Problem of Anxiety (repr. 1966);
Gittelman, Rachel, ed., Anxiety Disorders of Childhood (1986);
Goodwin, D. W.,
Anxiety (1986); May, Rollo,
The Meaning of Anxiety (1977);
Charles, ed., Anxiety and Behavior (1966);
M., and Spielberger, Charles D., eds., Emotions and Anxiety (1976).