Generalized anxiety disorder
Currently, the most significant mental health issue is anxiety, with fully one-third of the population affected. However, a very high number of these individuals remain untreated, a situation which may be explained by the fact that anxiety is subjective, complex and difficult to define. It is therefore necessary to distinguish between normal anxiety and so-called pathological anxiety, as well as differentiating anxiety, fear, phobia and stress.
Successive lifecycles may cause varying degrees of anxiety. Certain periods including adolescence, menopause and old age are particularly conducive to anxiety, as they require adaptation to the numerous profound changes occurring in the human body at these times.
Some scientists believe that anxiety is a conditioned reflex. According to one psychoanalytic theory, anxiety is the manifestation of an unconscious conflict, a disease, a fear or a disturbing psychological event that occurred during childhood. In some individuals, the mechanisms they have developed to cope with life events may cause a predisposition to anxiety. It is nevertheless important to remember that mild anxiety is useful, as it contributes to adaptability and encourages the individual to find solutions to pressing issue. It can be said to be a wellspring for action and change.
When anxiety becomes extreme and therefore pathological, it can alter and even paralyze an individual’s functional capabilities in most areas of life. Individuals suffering from acute anxiety may experience considerable difficulties in the workplace as well as in their domestic, sexual and social lives.
Fear and phobias
For its part, fear is an emotion similar to anxiety, but which typically manifests in response to a real and present danger or threat. Thus, it is normal to be afraid when coming across a bear in the woods. But if one worries about a routine medical exam for months in advance, one is said to be anxious.
When extreme fear is manifested in the face of a situation thought to be dangerous, and when it creates avoidant behaviour with regard to this situation, then we are dealing with a phobia. With phobias, the key is that the danger is not real. Many types of phobias exist related to animals, enclosed spaces, darkness, heights, etc.
Generalized stress and anxiety
Stress may be defined as a physiological and psychological reaction to an unexpected life crisis. For example, serious financial problems, a divorce or the loss of one’s job are obvious examples of stress triggers that can generate a high level of anxiety.
From an emotional standpoint, anxiety is considered normal as a response to a stressor. It evolves into pathology when prolonged exposure to stress creates a diffuse fear, when it is linked to anticipation of a negative event or an unidentified imminent danger, and when it generates pain and impairs normal function.
“In some ways, anxiety is the capacity to amplify and create your own stress.”
Excessive anxiety and worry over daily activities for a period exceeding six consecutive months.
This anxiety and worry is associated with three (or more) of the following symptoms:
- Difficulties with concentration or memory
- Muscle tension
- Sleep disturbances
Anxiety, and the worry and physical symptoms arising from it, can result in severe pain and functional changes/impairment in social, professional and other areas.
Anxiety does not have a unique, single cause. Rather, it is triggered by association with a cumulative set of physical (biological), psychological and environmental (stressors) factors.
- Biological factors or a variation of hereditary predisposition.
- Psychological factors, such as weak or inoperative defence mechanisms
Pathological anxiety may be generated by three types of illness:
- Physical diseases such as hyperthyroidism. In this case, anxiety is considered “secondary” and disperses after the patient is cured.
- Mental illnesses (other than anxiety disorders): depression, psychoses and bipolar disorder are often associated with a marked degree of anxiety. In these cases, improvements in the underlying mental disorders can considerably lower anxiety.
- The full range of anxiety disorders, including generalized anxiety, panic attacks, phobias and obsessive-compulsive disorder. When these disorders are present, anxiety is considered a “primary” (i.e. predominant) phenomenon.
Scientists are currently studying the role that heredity and brain biochemistry play in the genesis and production of anxiety disorders. It appears increasingly clear that biochemical imbalances are likely responsible for the occurrence of these diseases.
Who is at risk?
Generalized anxiety disorder (GAD) affects between 5-10% of the general population. Women are twice as likely to be afflicted as men.
Sufferers often consult in early adulthood, but claim they have always been anxious. They also often consult GPs or specialists for a variety of different, nonspecific physical complaints.
Moreover, 50-90% of individuals with generalized anxiety disorder also suffer from another mental illness. Panic disorder, depression and drug or alcohol abuse are frequently associated with GAD.
Prevention and care
Is it possible to talk about anxiety prevention? Yes – and no. When anxiety is primarily due to a situational and temporary problem over which we have some control, prevention may be possible through lifestyle changes. A healthy lifestyle may vastly reduce anxiety and enable it to revert back to tolerable levels.
Desirable health practices include:
- Proper balance between work, rest and leisure activities;
- Low consumption of alcohol, caffeine and nicotine;
- Good nutrition; and
Most importantly, regular exercise.
When anxiety is linked to individual biological and psychological factors, prevention becomes much more problematic. It goes without saying that a healthy lifestyle can only be a positive factor in recovery; however, in the case of pathological anxiety, patients should resort to a medical treatment which can be tailored to each individual case.
A number of studies have demonstrated the effectiveness of cognitive-behavioural therapy in treating anxiety disorders. This therapy provides patients with an opportunity to observe and analyze their anxious behaviours and thoughts, learn new behaviours, and substitute unwanted thoughts and emotions with more appropriate ones.
Cognitive-behavioural therapy is effective in both individual and group settings. Studies confirm that psychotherapeutic approaches are more effective in the long term than pharmacotherapy (drugs) in the management of anxiety disorders.
- Medication therapy
Antidepressants are effective in treating symptoms of depression and anxiety with rumination when the patient’s response to psychotherapy is limited.
Anxiolytics such as benzodiazepines are used primarily to treat somatic symptoms. Due to side effects and issues with addiction and weaning, these drugs are normally prescribed only for short-term use.
Antipsychotic drugs may be prescribed when the patient fails to respond to other drug therapies.
- Complementary approaches
Relaxation techniques and meditation
Breathing exercises can act quickly on anxiety and decrease the patient’s overall stress level after only a few weeks of regular practice. These exercises form the basis for most relaxation techniques; the key is regular practice, ideally twice daily. As time goes on, the degree of anxiety decreases and energy levels rise.
Relaxation techniques are plentiful, and have been shown to reduce stress and anxiety in general
Meditation encourages individuals to focus on their own breathing or on a single word, sound, symbol or image in order to achieve a state of deep relaxation while stimulating mind and spirit. Several types of meditation have been shown to reduce stress.
Support and self-help groups: To help sufferers break out of their isolation, these groups allow participants to interact, share their experiences and receive support and additional information.
Bibliotherapy or self-directed therapy
Supplementary reading effectively complements psychotherapy by encouraging patients to broaden their understanding of the disorder’s root causes, nature and treatment.
- Dr. David Burns: Être bien dans sa peau. Traitement éprouvé cliniquement pour vaincre la dépression, l’anxiété et les troubles de l’humeur. (1st edition) Saint-Lambert, Éditions Héritage, 1994.
- Sonia Lupien: Par amour du stress, Des conclusions scientifiques, Une présentation facile. Éditions au Carré, 2010.
Association / Troubles Anxieux du Québec (Anxiety Troubles Association)
Canadian Network for Mood and Anxiety Treatments
L’Ordre des psychologues du Québec (Quebec’s Psychologists Order)
(514) 738-1881 ou 1-888-731-9420
Revivre (Association for people suffering from anxiety, bipolar disorder or depression)
Ligne d’écoute : (514) 738-4873 ou 1.866.REVIVRE
La Clé des Champs (Peer network for people living with an anxiety disorders)
Phobies-Zéro : (Help groups for youth and adults suffering from anxiety disorders – all around Quebec)
Ligne d’écoute et de soutien : (514) 276-3105 ou 1-866-0002
Groupe d’Entraide G.E.M.E. (Help group for better living)
(450) 462-4363, numéro sans frais : 1-866-443-4363
FFAPAMM (Friends and families of people suffering from mental illness)
Association québécoise de prévention du suicide (Suicide prevention)
24 heures/ jour, 7 jours/7 partout au Québec
1-866 APPELLE (277-3553)