Anxiety Health Article

Alternative treatment

Alternative treatments for anxiety cover a variety of approaches. Meditation and mindfulness training are thought to be beneficial to patients with phobias and panic disorders. Hydrotherapy and aromatherapy can be useful to some anxious patients by promoting general relaxation of the nervous system. Yoga, aikido, tai chi, and dance therapy can help patients work with the physical, as well as the emotional, tensions that either promote anxiety or are created by the anxiety.

Prognosis

The prognosis for resolution of anxiety depends on the specific disorder and a wide variety of factors, including

the patient's age, sex, general health, living situation, belief system, social support network, and responses to different anxiolytic medications and forms of therapy. Success rates using pharmacologic therapy in patients with acute anxiety is between 50% and 70%. Success rates using antidepressants in patients with chronic or generalized anxiety are lower. Anxiety disorders typically involve a complex interaction of psychologic and physiologic factors. They are not easy to treat and do not disappear with great ease. Medications, behavioral techniques, and psychotherapy can be successful to varying degrees. The best outcomes occur when the anxiety-panic-phobia-depression cycle that is commonly found in these patients is disrupted. Anxiety should be viewed as a chronic condition that may involve an occasional increase in the severity of symptoms.

Health care team roles

Allied health personnel may be involved in the diagnosis and treatment of persons with anxiety at a variety of stages. Nurses will likely be involved in the initial interview of patients who present with anxiety. Psychological technicians may help conduct a more in-depth interview. Radiologic technicians play an important role in the process by conducting tests that help rule out conditions such as cardiovascular disease, hyperthyroidism, and myasthenia gravis. Nurse practitioners and physician assistants will often make the diagnosis of anxiety.

Pharmacists play a large role in the proper treatment of patients with anxiety because they dispense the drugs that are so important in the therapy of these patients. They also provide essential information on how to properly use these drugs to achieve peak effectiveness. Technicians may also be involved if the patient receives biofeedback, relaxation training, or cognitive-behavioral therapy.

Prevention

Humans have significant control over thoughts, and, therefore, may learn ways of preventing anxiety by changing irrational ideas and beliefs. Humans also have some power over anxiety arising from social and environmental conditions. Other forms of anxiety, however, are built into the human organism and its life cycle, and cannot be prevented or eliminated. Some cognitive-behavioral techniques may be effective in preventing more serious anxiety when applied at an early stage.

KEY TERMS

Affect—An observed emotional expression or response. In some situations, anxiety would be considered an inappropriate affect.

Anxiolytic—A type of medication that helps to relieve anxiety.

Autonomic nervous system (ANS)—The part of the nervous system that supplies nerve endings in the blood vessels, heart, intestines, glands, and smooth muscles, and governs their involuntary functioning. The autonomic nervous system is responsible for the biochemical changes involved in experiences of anxiety.

Endocrine gland—A ductless gland, such as the pituitary, thyroid, or adrenal gland, that secretes its products directly into the blood or lymph.

Free-floating anxiety—Anxiety that lacks a definite focus or content.

Hyperarousal—A state or condition of muscular and emotional tension produced by hormones released during the fight-or-flight reaction.

Hypothalamus—A portion of the brain that regulates the autonomic nervous system, the release of hormones from the pituitary gland, sleep cycles, and body temperature.

Limbic system—A group of structures in the brain that includes the hypothalamus, amygdala, and hippocampus. The limbic system plays an important part in regulation of human moods and emotions. Many psychiatric disorders are related to malfunctioning of the limbic system.

Phobia—In psychoanalytic theory, a psychological defense against anxiety in which the patient displaces anxious feelings onto an external object, activity, or situation.

BOOKS

"Anxiety." In Current Therapy. Conn, H.F., et al., eds. Philadelphia, PA: WB Saunders, 1998.

"Anxiety." In Ferri's Clinical Advisor. Ferri, Fred F., ed. St. Louis, MO: Mosby, 2001.

"Anxiety Disorders." In Cecil Textbook of Medicine, 21st ed. Goldman, Lee and J. Claude Bennett, eds. Philadelphia, PA: WB Saunders, 2000

"Anxiety Disorders." In Harrison's Principles of Internal Medicine, 14th ed. New York, NY: McGraw-Hill, 1998.

"Generalized Anxiety Disorder." In Current Medical Diagnosis & Treatment, 40th ed. Reinhardt, S., J. Ransom, et al., eds. New York, NY: McGraw-Hill, 2001.

Mark A. Mitchell, M.D.