Best Anxiety Disorder Treatment | Mindoc

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Anxiety Disorders
What is an anxiety disorder? Anxiety is one of
the most common emotional states that humans
express. Hence it is generally considered
normal. Fear and anxiety often go hand in hand
but fear is a response to an imminent danger
similar to one expressed by a man being
approached by a bear. However, anxiety occurs
even when there is no obvious imminent danger.
This seem to be a developmentally advanced form
of fear stemming out of a human beings ability
to predict, symbolically represent or often
misrepresent emotionally relevant stimuli. This
could be based on past experience or learning
for instance, a child brought up in an
environment of family violence is likely to be
more sensitive to perceived threat of violence
from others. However, a diagnosis of anxiety
disorder is made only when your anxiety gets out
of control and starts to affect multiple aspects
of your life. Anxiety disorders are Australia and
New Zealands most prevalent mental health
issue. At some point in our lives, about 1 in 3
of us will have an anxiety disorder. What
causes anxiety Its normal and healthy to feel
anxious sometimes. Anxiety actually helps us. It
makes us alert and helps us do things well. For
instance, you may want to perform well in the
exams and have prepared well too, however, you
cant stop thinking about the possibility of
messing up on the day. Hence the reward of
getting a good result and the punishment of a
bad result co-occur at the same time in your
mind. So, most of us try to prepare well to
ensure we get rewarded at the end, but if we
feel it is too hard, we might as well think of
the alternate possibility of punishment (bad
result). Hence there is a delicate balance of
appraisal of the situation which is yet to
happen. Most rewarding things in life often come
with significant risk of punishment otherwise
called failure. The way we appraise such
situations depends a lot on our personality. A
perfectionist might underestimate their exam
preparation and exaggerate their risk of
failure. However actual results might prove
otherwise. Over a period of time, they might
become aware of this pattern and may be able to
go through this anxiety.
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However, for some others, this might lead to
avoidance. This can happen if someone has a poor
self-esteem coupled with a need for external
validation or if one has a childhood which made
them feel inferior or inadequate. Hence anxiety
disorders originate from a erroneous appraisal
of a situation but it becomes a disorder only
when it becomes entrenched patterns of behaviour
causing dysfunction in more than one area of
life. Signs and symptoms of anxiety
disorders People with an anxiety disorder have
very strong feelings of worry or fear. They are
disproportionately more anxious than most people
would be in the same situation. They may go out
of their way to avoid things, people, events or
places. Anxiety is a perfect example of the
mind-body continuum Some people would recognise
that they are anxious as they start shaking,
their hear starts pounding or when they feel dry
in their mouth or are unable to speak or
breathe. Those who had severe panic attacks often
go the emergency department thinking it is a
heart attack or stroke. But in retrospect, most
people are able to link it with their emotional
state. Studies have shown that the anxiety
states are linked to heart rate variability,
respiratory changes and EEG (Electrical tracing
of the brain) and EMG(tracing of the muscle)
changes. Who gets anxiety disorders? Anxiety
disorders most often start when people are
teenagers. However, it can start as early as in
their childhood. They are more common among women
and girls. They are also more common in people
who were neglected/abused as children, or who are
neglected/abused as adults. A person doesnt
need to have suffered trauma to have anxiety.
Some anxiety disorders can run in families.
There is a 3-5-fold increased chance of someone
developing an anxiety disorder if they have a
close relative with Anxiety. For some
individuals, a single event can trigger an
episode of anxiety but for some, it can build up
over time from various sources such as events at
home, work, and in relationships until the worry
and distress develop into an anxiety disorder.
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How does brain produce Anxiety? Our emotion is an
evolutionary gift that nature has given us.
Although other mammals are also able to express
emotions, humans are different as they able to
modify raw emotions by virtue of a more
developed brain(neocortex). This also comes with
its pitfalls, our ability for abstraction and
symbolic representation might also lead us to
misrepresent our competence, conceal motivations
or express emotions triggered by past experiences
rather than based on current circumstances. Why
does this happen to us but no other animals? This
is because broadly there are two brain centres
for regulation of emotion, one the Limbic system-
the primitive seat of emotion and the frontal
cortex , the more advanced and rational part of
the brain which makes us humans. Our sensations,
movements and emotions flow through nerves which
are packed closely together connecting these
centres. From your own experience you might have
noticed that some events or goals are more
emotionally relevant to you than the others. Yet
your responses may vary or even can be
contradictory. Why would this happen? Certain
brain regions such as Amygdala, Anterior
Cingulate cortex (parts of limbic system)
together with the pre-frontal cortex (PFC)
determine the significance (reward-punishment) of
these stimuli. Whilst the left cortex might ask
you to seek out the rewarding stimuli , the right
cortex might activate avoidance. You may be able
to relate it to a date night situation where you
contemplate whether or not to approach a person
you feel attracted to. If you have had prior
negative social experiences, the seat of
emotional memory-hippocampus would remember it.
Hippocampus will then create a fear response by
activating amygdala and pituitary adrenal axis.
Moreover, this might also activate the adrenergic
centres of the brain causing a flight or fight
response. The subsequent neuro-chemical cascade
would also reduce your attention span, your
ability to think rationally and to act logically.
As explained above, it can cause sensory and
motor symptoms commonly known as dissociation
as these centres are closely packed together.
Once you had such a negative experience, your
brain would remember it, code it and store it
mainly via hippocampus and process it later via
the Pre-
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frontal cortex. When you think about another date
night, this might trigger a fear response via
the activation of a centre called bed nucleus of
stria terminals (BNST), which we call
anticipatory anxiety. What is the role of
chemicals in causing Anxiety? Monoamine systems
are implicated in the causation of depression as
they seem to regulate a wide range of emotions.
They are also intricately linked and
counter-balance each other. Noradrenaline (NA)is
involved in alertness and emotional memory.
It is involved in the regulation stress
related behavioural and physiological responses.
Chronic adrenergic surge (chronic stress) can
cause a state of learned helplessness. This can
also lead to a state of low energy, attentional
deficits and anhedonia. There is ample evidence
from research suggesting dysfunction of NA in
PTSD. There is increased NA activity both
peripherally and centrally in those with PTSD or
childhood sexual trauma and they are often
hyper-sensitive to NA blockers such as
Catapres. Cortisol is considered to be the
stress hormone which contributes to increased
arousal, vigilance, focussed attention and
memory formation. It can also inhibit the
reproductive system and immune response. The
secretion of cortisol is regulated via the
amygdala and hippocampus but through a feedback
system it does modify the function of amygdala
and hippocampus in addition to influencing the
NA system. Dopamine mediates motivational
responses. The dopamine in the medial prefrontal
cortex is sensitive to stress and this
sensitivity in part, genetically determined. The
dopamine receptor gene called DRD2 may be
involved in the pathogenesis of not only PTSD but
also substance use and ADHD and Tourettes. As
explained in other sections, many behavioural
disorders are likely to have few underlying
traits as explained by the inverted Iceberg
hypothesis. What can psychiatrists do to help
with your anxiety? Psychiatrists at Mindoc are
highly experienced in treating anxiety disorders.
The first step in helping you with your anxiety
would be a detailed evaluation to understand you
as a person
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and your circumstances. Well try to identify the
components of your anxiety and its
predispositions, will aim to make an accurate
diagnosis and prepare a management plan in
collaboration with you. We are happy to work with
your psychologist or your GP to ensure the best
outcome for you. Mindoc Telephone
61385783188 Mobile No 61490029491 Fax (03) 8579
6897 Find Us on Maps https//g.page/mindoc-psychi
atry-clinic