ANXIETY

INTRODUCTION – ANXIETY

Stress is a common health problem. Statistics show that about 90% of patients who consult a primary healthcare provider are suffering from stress-related disease, with 30 to 40% of the population suffering stress at any one time.

When stress creates uncertainty, it gives rise to anxiety. Many of us can attest to feeling anxious just before an examination, a job interview or a public speaking appearance. The reason we feel anxious is that we are not sure of the outcome as we do not feel totally in control. Thus, the more we experience the same environment or activity, the less likely we are to feel anxious about it.

We feel anxious because our Autonomic Nervous System goes into a state of overdrive, producing large amounts of adrenaline and noradrenaline, which stimulate the heart, lungs, intestines, muscles and sweat glands to excessive activity. Normally, our anxious feeling does not last very long because our nervous system recognizes that it is over working and readjusts to a slower pace. If the nervous system continues with its over activity, then an anxiety disorder may develop.

Types of anxiety disorders

Anxiety disorders are common among the general population. The incidence among children and adolescents is about 20%. Many are quiet sufferers because they do not know that the condition is treatable and feel embarrassed or are worried that they are ‘weird’. Anxiety disorders can be classified as follows:

  • Generalized anxiety disorder. The sufferer is worried about most situations or things in his life.
  • Specific phobia. The sufferer has a specific fear of things such as height, spiders, open spaces or hairy objects.
  • Social phobia. The individual is anxious about social situations because he/she thinks that he/she is under the scrutiny of the other people.
  • Panic disorder. The person experiences repeated anxiety attacks which happen spontaneously. The anxiety symptoms may include shortness of breath, pins and needles sensation, dizziness and chest tightness etc. Agoraphobia may develop when the person avoids public places where he/she has suffered one or more anxiety attacks.
  • Obsessive-compulsive disorder. The person experiences obsessions which are recurrent and persistent impulses, images or thoughts that are anxiety provoking. The person develops repetitive and compulsive behaviour to deal with the obsessions. These compulsive behaviour may include checking, cleaning, and counting etc.
  • Separation anxiety disorder. A young person experiences anxious feeling whenever he/she is separated from a figure of security, such as the mother or father.
  • Post-traumatic stress disorder. Where a person has experienced a stress of such overwhelming severity that the person’s nervous system does not recover from the shock. Consequently, the person experiences anxiety symptoms continuously even after the cessation of the stress. Some examples include victims of abuse, armed hold up or terrorist attack.

Sometimes, anxiety disorders can masquerade as drinking and drug problems among young people.

Treatments for anxiety problems

There are many types of treatment for anxiety. Make sure that you research thoroughly before you commit your child or yourself to a treatment. It is your right to ask your doctor or other health professional as many questions as you need to feel completely satisfied.

The following list represents most of the available treatments for anxiety:

  1. Medication. Doctors usually use this very judiciously. The younger the child, the less willing is the doctor to use medication. If the doctor does prescribe medication, he/she will probably prescribe an antidepressant, which in a smaller dose acts as a relaxant. Drugs such as Valium are highly addictive and best to be avoided.
  2. Relaxation therapy. This helps to lower the stress level in the body by activating the Parasympathetic Nervous System, which counteracts the fight-flight response.
  3. Hypnosis. This is a form of treatment that induces a different state of consciousness in the patient. This state of consciousness is different from normal waking and sleeping states. When a person is in a hypnotic state, his ability to unlearn old and maladaptive habits and to learn new and adaptive habits is increased.
  4. Individual therapy. In this case the therapist deals with the person on an individual basis. The therapeutic framework may include cognitive therapy, psychodynamic therapy and behaviour therapy. Cognitive therapy is based on the premise that thought precedes emotion. To change our emotions, we just need to change our thinking. Psychodynamic therapy is based on the premise that there are unconscious inner motivations that drive us to behave in a certain ways. Understanding our motivations, therefore, helps us to change the ways that we behave. Behaviour therapy is based on the premise that one’s behaviour can be reinforced by rewards and extinguished by punishment.
  5. Family therapy. Sometimes your child’s anxiety may be related to the functioning or the dynamics within the family, such as the arrival of a new sibling, parental favouritism of one child over another and parental marital discord. Family therapy can also be used when the anxiety of the young person impacts on the family. For example, the anxious young person may take up so much of the parents’ time that the other siblings are neglected. The neglected siblings may react in an angry or aggressive fashion.
  6. Environmental manipulation. This includes the therapist liaising with and providing inputs and consultation to the school, college and other significant systems in which the young person is involved so that he/she may receive optimal help. For example, in the case of school refusal as a result of a separation anxiety disorder, the school counsellor may play a vital role in helping the young person to go back to school. In other cases, the therapist may need to be an advocate for the young person, so that his education or work may not be compromised.

The above treatments are not mutually exclusive. The psychiatrist may use one or more modalities of treatment. Generally, cognitive therapy offers a quicker response than psychodynamic therapy. Personally, I prefer to use a combination of relaxation therapy, neurolinguistic techniques and cognitive therapy. In other cases, where there are some deep seated and unresolved issues, psychodynamic therapy may be offered after the person has received some immediate or short term relief from relaxation therapy and mindfulness exercise.

The role of the parent in helping an anxious child

Parents often wonder what they can do to help their children who are suffering from anxiety. Here are some suggestions:

  1. Be supportive of your child and the treatment that he receives. Your support will go a long way to help the recovery.
  2. Deal with your own problems or issues. Sometimes the source of the child’s anxiety is found within the family. For example, the child may develop a separation anxiety disorder because of the parents’ marital problems.
  3. Attempt to understand your child’s problem. Anxiety is not a moral weakness. People who suffer from anxiety are frequently misunderstood. As they do not have a broken leg or other outward signs of an illness, they often do not get the understanding that they deserve.
  4. Understand your child’s personality. Whilst your child’s problem is not a personality flaw, your child may have a personality that predisposes him/her to develop anxiety. Children who are born with high trait anxiety (having an anxious temperament) tend to develop an anxiety disorder when under stress. The temperament of these children is quite obvious from birth. As babies, they take a long time to warm up to new people, activities or stimuli, and withdraw from novel situations. When they grow up, they do not take challenges well and are easily stressed. On the other hand, children who are perfectionistic and overly conscientious are more prone to developing depression. Please note that there is no such thing as a perfect personality, only different strengths and weaknesses. For example, children who are perfectionists are usually high achievers and self-motivated, which is positive. However, they tend to be unnecessarily harsh on themselves and drive themselves to the point of depression. As parents, our task is to guide our children to maximise their potential and achieve optimal psychological health.
  5. Participate in the treatment program with your child. For example, your child may be instructed to do daily relaxation exercises. Your child will have a far greater chance of success if you do the exercises with him/her. Needless to say, one should back off if your participation creates difficulties between you and your child.
  6. Modulate life events for your child. Life events are those extraordinary experiences that require adaptation from us. Life events usually precede stress. Most people cannot cope with more than two life events at the same time without succumbing to the stress. Since your child is dependent on you, you need to act as his/her barometer of stress and minimise his/her exposure to too many life events.
  7. Buy a home-based self-help program. This is an invaluable investment that expedites your child’s recovery. You child can use it again and again. Through this program, you and your child will have a greater participation and control over his/her treatment. Your child will feel empowered.
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