by Keith Sonnanburg, Ph.D.
Clinical Psychologist
There are many occasions when it is normal to feel anxious. We may get "the jitters" when preparing for a job interview, taking a big test, making a public presentation, awaiting the results of a medical examination, going on an airplane or being on a date. Some common reactions accompany such ordinary experiences of "nerves."
When anxious, we feel physical sensations like these: sweaty palms, dry mouth, stomach upset, dizziness, a racing or irregular heartbeat, tingling or numbness, rapid or shallow breathing, trembling or other muscle tension. These symptoms reflect the increased physiological arousal that anxiety generates. We might also notice worried thoughts and fearful anticipation, along with a heightened sense of vigilance. We may have a compelling desire to avoid certain situations or to escape our immediate circumstances. Bouts of anxiety can include more general experiences of low self-confidence, unreality, emotional detachment, or self-alienation. Levels of discomfort can escalate to disabling fears of losing control, going crazy or even of dying.
Clinical levels of anxiety are the predominant feature of several distinct presentations: simple phobias, social phobias, agoraphobia, panic disorder, generalized anxiety disorder, obsessive-compulsive disorder, and post-traumatic stress disorder. Other psychological problems are also accompanied by severe anxiety (for example, somatic disorders, substance abuse disorders or dissociative disorders).
The same anxiety symptoms can arise for many different causes: an excitable temperament, relationships with caregivers, cultural inhibition of ordinary emotions, the impact of a general medical condition, reactions to stressors (like personal loss, life changes or physical threats) and learned responses to various events. Since there are medical conditions that produce anxiety symptoms, a physician should be consulted to rule out such diagnoses before seeking psychological help. Once acquired, maladaptive anxiety is perpetuated by: mistaken interpretations, disproportionate appraisals, avoidance of perceived threats, inadequate coping skills, unexpressed or suppressed emotions, neglible self-nurturing skills, the use of stimulants, poor diet, a high-stress lifestyle, a lack of meaning or purpose and the maintenance of chronic muscle tension.
Usually, people who suffer from anxiety disorders recognize their emotional response as excessive. Other times, guidance and reassurance from a trusted source leads to seeking professional help. If health or vocational performance is jeopardized by lack of sleep, psychotropic medications can be an aid for the short-term. However, many of the drugs used to ease acute anxiety are addictive. More recently, the SSRIs (i.e., serotonin specific reuptake inhibitors) have helped some people to tolerate their anxiety. Some, however, complain of side-effects or a sense of emotional dullness from such medicines.
There are effective psychotherapy interventions for all forms of anxiety disorders. Although certain cases of extreme anxiety respond to a combination of psychotherapy and medication, studies have shown that those who receive psychotherapy without medication generally experience better long-term adjustments and increasingly beneficial effects over time.
People who suffer from extreme anxiety can enjoy relief. There is no need to remain "all stressed out." Peace of mind is established by learning to self-regulate emotions, cope with panic, respond effectively in fearful situations, relax oneself, improve self-regard, negotiate interpersonal relationships, find existential or spiritual meaning, and maintain a healthy lifestyle.