Anxiety

DEFINITION

• Anxiety is described as painful uneasiness, knowing something is not quite right.
• This feeling of unrest influences thoughts and actions.

FACTS

• Everyone is born with some amount of anxiety. Some people have very little and others have an extra large amount, sometimes described as a hummingbird in the chest.
• Anxiety allows an individual to inspect the environment and assess for safety. In this way, anxiety is protective, but it also creates illusions that interactions with the environment are safe. Otherwise no one would drive a car of cook over a hot flame.
• Anxiety is not a weakness and can, in fact, lead to great successes in life.
• Children are born with anxiety but also learn anxiety from family members. Often a person with anxiety can look back to the parents and identify one or both with an excessive amount.
• Anxiety will always be present and increases with age when parts of the brain that help to control it naturally begin to change.

SOURCES OF ANXIETY

• A significant tragedy may create anxiety at the time of the event and may trigger a post-traumatic stress disorder (PTSD).
  • PTSD may present itself immediately or years after the event occurred.
• The compilation of multiple small stressful events over a lifetime can lead to anxiety as one ages.
  • Positive emotions and the stories that created them are more difficult to remember then negative emotions. It is how the human brain is wired.

SIGNS AND SYMPTOMS OF ANXIETY

• Physical
  • Elevated heart rate
  • Increased breathing
  • Sweating
  • Shaking
  • Headache
  • Abdominal pain
  • Difficulty sleeping
• Impatience
  • An inability to use reason to understand and solve problems.
• Distraction
  • An inability to focus may impact memory. In older people, this forgetfulness may then increase anxiety even more.
  • Inability to be “in the moment”.
• Anger
  • Brain chemicals associated with anxiety are the same as those associated with anger.
  • Perceived threats to safety can cause outbursts of anger.
• Obsessions
  • Messages, often negative ones, play over and over in the mind.
• Fear
  • Unchecked anxiety may lead to fear which may be seen as unreasonable by others.
  • A common fear for an older person with anxiety is running out of money.

COMPULSIONS TO MANAGE ANXIETY

• Anxiety is always expressed with an obsession(s). Obsessions are controlled by compulsions.
  • A compulsion is a repeated behavior or ritual.
  • Anxiety is reduced when the compulsive behavior is occurring.
  • Removing the compulsive behavior will result in increased anxiety.
  • Examples of compulsions
    • Hoarding
    • Frequent use of the computer
    • Pacing
    • Repeated behaviors such as checking if doors are locked or the stove is turned off
    • Creating order with files, pantry items, etc.
    • Excessive shopping or gambling
  • People with anxiety may try to self-medicate and turn to alcohol or illegal drugs to manage it.

STRATEGIES TO HELP MANAGE ANXIETY

• There are many strategies to help navigate anxiety. This is not an exhaustive list but are some recommended strategies to help manage anxiety.
• Engage the senses
  • Hearing
    • Music
    • Soft voice
  • Sight
    • Low lights
    • Pleasant, relaxing environment
  • Touch
    • Gentle hand holding
    • Stroking the face
  • Smell
    • Flowers
    • Cooking aromas
  • Taste
    • Favorite comfort foods
  • Engage in physical activities that increase the heart rate such as walks, jogs, weightlifting, or a sporting activity.
  • Engage in activities to quiet the body such as deep breathing, progressive muscle relaxation and gentle stretching.
  • Use positive words of affirmation and avoid negative messages.
  • Medications to control anxiety may be needed. Common drug classes are:
    • SSRI – serotonin selective reuptake inhibitors
      • Examples are sertraline, escitalopram, and fluoxetine.
    • SNRI – serotonin norepinephrine reuptake inhibitors
      • Examples are duloxetine and venlafaxine.
    • Benzodiazepines
      • Providers at MMC strongly recommend these medications NOT be used due to the long term effects.
      • Stopping these medications must be done under the care of a provider.
      • Examples of these medications are alprazolam (Xanax), lorazepam (Ativan), diazepam (Valium) and clonazepam (Klonopin).
    • Referral to a counselor to learn techniques to manage anxiety is an important part of the treatment plan for excessive anxiety. Medications in combination with counseling is more effective than medication alone.