The Malta Independent on Sunday

The silent struggle: Understand­ing anxiety

- PROF. RENALD BLUNDELL ANDREA WERONIKA GIELETA Prof. Renald Blundell is a biochemist and biotechnol­ogist with a special interest in Natural and Alternativ­e Medicine. He is a professor at the Faculty of Medicine and Surgery, University of Malta. Andrea Wero

Anxiety is an emotion characteri­zed by an unpleasant state including feeling of uneasiness, worry which can manifest both physically and mentally. Anxiety differs from fear in that fear is an emotional response to an actual stressful event whereas anxiety is an anticipati­on of a potential threat.

The feeling of anxiety can persist way beyond the explainabl­e period in a response to life events and therefore becoming one of the many anxiety disorders such as generalize­d anxiety disorder or panic disorder. Anxiety disorder can be differenti­ated from anxiety based on a time frame. Most individual­s suffering from anxiety disorder experience anxiety on most days for a period of 6 months. Anxiety disorders are one of the most common mental problems which unfortunat­ely tend to last for decades. Recognizin­g the symptoms of anxiety is crucial for early interventi­on and effective management.

Physical symptoms of anxiety

Anxiety commonly produces a variety of physical symptoms that can mimic other medical conditions. These symptoms include:

Rapid Heartbeat (Palpitatio­ns): Individual­s with anxiety can experience an accelerate­d heart rate, even in non-stressful situations.

Shortness of Breath: A feeling of breathless­ness or suffocatio­n is a common manifestat­ion of anxiety.

Muscle Tension: Muscle stiffness and tension, especially in the neck, shoulders, and back, can present as a physical response to anxiety.

Sweating: Profuse sweating, even when not due to physical exertion or heat, is a frequent symptom of anxiety.

Trembling/Shaking: Uncontroll­able trembling or shivering, often in the hands or limbs, can present during anxiety episodes.

Gastrointe­stinal Symptoms: Nausea, stomach upset, and diarrhoea are common gastrointe­stinal manifestat­ions of anxiety.

Different types of anxiety disorders

Generalize­d Anxiety Disorder (GAD): Persistent and excessive worry about a wide range of everyday concerns.

Panic disorder: Recurrent, unexpected panic attacks characteri­zed by intense fear and physical symptoms.

Social anxiety disorder: Intense fear of social situations and a strong desire to avoid them.

Specific phobias: Intense fear and avoidance of specific objects or situations (e.g., fear of flying, fear of spiders).

Obsessive-Compulsive Disorder (OCD): Characteri­zed by intrusive, unwanted thoughts (obsessions) and repetitive behaviours (compulsion­s) to reduce anxiety.

Post-Traumatic Stress Disorder (PTSD): Occurs after exposure to a traumatic event and involves symptoms such as flashbacks, nightmares, and severe anxiety.

Separation anxiety disorder: Most seen in children, it involves excessive fear or anxiety about being separated from caregivers.

Diagnosis

Diagnosing anxiety typically includes a comprehens­ive assessment by a qualified healthcare profession­al, such as a psychiatri­st, psychologi­st, or general practition­er. There are no specific laboratory tests or imaging studies that can definitive­ly diagnose anxiety disorders. The diagnosis relies on a combinatio­n of clinical evaluation, medical history, as well as presentati­on of symptoms.

The healthcare profession­al shall conduct a thorough clinical assessment, which involves obtaining informatio­n about symptoms, duration, and their impact on daily life.

Further assessment should involve asking about other medical conditions, medication­s, substance misuse, as well as family history of mental health issues.

Standardiz­ed diagnostic criteria are usually used, such as those outlined in the Diagnostic and Statistica­l Manual of Mental Disorders (DSM-5), to determine if the individual’s symptoms meet the criteria for a specific anxiety disorder (for instance Generalize­d Anxiety Disorder, Panic Disorder, Social Anxiety Disorder). A physical examinatio­n should be performed to exclude any underlying medical conditions that could be causing the symptoms.

Treatment

The treatment of anxiety disorders typically involves a combinatio­n of therapeuti­c approaches, lifestyle changes, and sometimes medication, depending on the severity of the condition and individual needs.

Cognitive-Behavioura­l Therapy (CBT): CBT is a highly effective therapeuti­c approach for various anxiety disorders. It helps individual­s identify and change negative thought patterns and behaviours contributi­ng to anxiety. Exposure therapy, a subtype of CBT, is particular­ly useful for treating specific phobias and OCD.

Acceptance and Commitment Therapy (ACT): ACT focuses on accepting anxious thoughts and feelings and committing to positive behavioura­l changes aligned with personal values.

Dialectica­l-Behaviour Therapy (DBT): DBT combines elements of cognitive-behavioura­l techniques with mindfulnes­s strategies, helping individual­s regulate emotions and cope with distress.

Medication­s

Antidepres­sants: Selective Serotonin Reuptake Inhibitors (SSRIs) and Serotonin-Norepineph­rine Reuptake Inhibitors (SNRIs) are commonly prescribed for anxiety disorders.

Benzodiaze­pines such as diazepam/alprazolam can be taken for short-term relief but are generally avoided for longterm use due to the high risk of dependence.

Lifestyle Changes

Stress management: Learning stress-reduction techniques, such as mindfulnes­s meditation, deep breathing exercises, or progressiv­e muscle relaxation, can help in anxiety management.

Regular exercise: Physical activity has been shown to reduce symptoms of anxiety and improve overall mental well-being.

Healthy diet: A balanced diet can positively influence mood and anxiety. Limiting caffeine and alcohol intake also proved to be beneficial.

Adequate sleep: Ensuring a regular sleep schedule and obtaining enough sleep is crucial for managing anxiety.

Avoiding substance abuse: Alcohol as well as recreation­al drugs exacerbate anxiety symptoms, therefore it is essential to avoid their use.

Support Groups

Group therapy or support groups can provide a sense of community and understand­ing for individual­s with anxiety disorders. Sharing experience­s and coping strategies can be valuable.

Medical evaluation

Ensuring that there are no underlying medical conditions contributi­ng to anxiety such as thyroid disorders.

Supplement­s

Several supplement­s have been studied for their potential to help manage anxiety symptoms.

Omega-3 fatty acids: Omega-3 fatty acids, found in fish oil supplement­s, have anti-inflammato­ry properties, and help with anxiety. Moreover, they are important for overall brain health.

Magnesium: Magnesium is a mineral that plays a role in various bodily functions, including nerve function as well as muscle relaxation.

L-Theanine: L-theanine is an amino acid found in tea leaves, particular­ly in green tea. It has calming effects and promotes relaxation.

Valerian Root: Valerian is an herb commonly used to promote relaxation and improve sleep.

Ashwagandh­a: Ashwagandh­a is an adaptogeni­c herb which aids the body react better. During stressful situations.

Kava: Kava is a plant native to the South Pacific, and its root extract has been used traditiona­lly as a natural remedy for anxiety and stress.

Concluding, recognitio­n of the anxiety symptoms of is the first step toward effective management and treatment. Anxiety is a treatable condition, and individual­s experienci­ng symptoms should not be hesitant with regards to seeking help. Early interventi­on together with appropriat­e treatment significan­tly improve the quality of life and well-being.

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