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Anxiety

What is anxiety?

Anxiety is an uncomfortable inner feeling of fear or imminent disaster. Most of us experience some temporary degree of anxiety in our lives, sometimes with just cause and at other times without. It can be a common normal human reaction to stress, and being anxious over appropriate things may help to make us more responsible, caring people. Some people, however, are constantly anxious to the extent that it is abnormal and interferes with their lives. Severe cases of anxiety can lead to panic attacks or hyperventilation.

What are the symptoms?

The symptoms can vary enormously from feeling tense and tired to panic attacks. Symptoms include:

• tiredness or fatigue
• dry mouth, difficulty swallowing
• apprehension: 'something awful will happen'
• sleep disturbances and nightmares
• irritability
• muscle tension/headache
• rapid heart rate and breathing
• sweating
• trembling
• diarrhoea
• flare-up of an illness (e.g. dermatitis, asthma)
• sexual problems

What are the risks?

Various physical illnesses-such as high blood pressure, coronary disease, asthma and perhaps cancer-can be related to persistent stress and anxiety. It may aggravate a drug problem such as smoking and drinking excessively. It can cause a breakdown in relationships and work performance. It can lead to the serious disorder of depression. Because an overactive thyroid can mimic an anxiety state, it is important not to overlook it.

What is the treatment?

Self-help

It is best to avoid drugs if possible and to look at factors in your lifestyle that cause you stress and anxiety and modify or remove them (if possible). Be on the lookout for solutions. Examples are changing jobs and keeping away from people or situations that upset you. Sometimes confronting people and talking things over will help.

Special advice

Be less of a perfectionist: do not be a slave to the clock; do not bottle things up; stop feeling guilty; approve of yourself and others; express yourself and your anger. Resolve all personal conflicts. Make friends and be happy. Keep a positive outlook on life, and be moderate and less intense in your activities. Seek a balance of activities, such as recreation, meditation, reading, rest, exercise and family/social activities.

Relaxation

• Learn to relax your mind and body: seek out special relaxation programs such as yoga and meditation. Make a commitment to yourself to spend some time every day practising relaxation. About 20 minutes twice a day is ideal, but you might want to start with only 10 minutes.
• Sit in a quiet place with your eyes closed, but remain alert and awake if you can. Focus your mind on the different muscle groups in your body, starting at the forehead and slowly going down to the toes. Relax the muscles as much as you can.
• Pay attention to your breathing: listen to the sound of your breath for the next few minutes. Breathe in and out slowly and deeply.
• Next, begin to repeat the word 'relax' silently in your mind at your own pace. When other thoughts distract, calmly return to the word 'relax'.
• Just 'let go': this is a quiet time for yourself, in which the stresses in body and mind are balanced or reduced.

Medication

Doctors tend to recommend tranquillisers only as a last resort or to help you cope with a very stressful temporary period when your anxiety is severe and you cannot cope without extra help. Tranquillisers can be very effective if used sensibly and for short periods.

Recommended reading:

• Herbert Benson, The Relaxation Response, Collins, London, 1984.
• Dale Carnegie, How to Stop Worrying and Start Living, Rev. edn, ed. Dorothy Carnegie, Angus & Robertson, Sydney, 1985.
• Ainslie Meares, Relief without Drugs, Fontana, Glasgow, 1983.
• Norman Peale, The Power of Positive Thinking, Cedar, London, 1982.
• Claire Weekes, Peace from Nervous Suffering, Angus & Robertson, London, 1972.
• Claire Weekes, Self-Help for your Nerves, Angus & Robertson, London, 1976.

Copyright 1995: John Murtagh, Professor of General Practice
Monash University, Melbourne, Australia