Veterans' Health Issues Main Index

Treatment may be necessary to overcome chronic anxiety

BY DR. NELDA P. WRAY
Is being "anxious" the same as being nervous or worried?

It depends on how we use the word. Anxiety can be a normal emotion we all experience. It can keep you from danger and protect your life. If you are anxious because you know your car's brakes are worn, this feeling may help ensure that you have them replaced so you can drive safely. If you feel somewhat anxious before a job interview or presentation, this is a normal response that may enhance your preparation and increase your alertness.However, anxiety becomes a mental illness when it begins to impair the ability to function rather than protect well being. Most anxiety disorders are caused by some interplay of genetics, psychological makeup, biochemical imbalances and stressful life events. These illnesses include:

1. . Generalized anxiety disorder, excessive worry or tension with no apparent or substantial cause that lasts at least six months.
2. . Panic disorders marked by sudden attacks of extreme fear, seemingly irrational attacks that last 30 to 90 minutes.
3. . Simple phobias involving an irrational ongoing fear of one thing or event, such as crowded places, flying or spiders.
4. . Post-traumatic stress disorder, reoccurring emotional distress following frightening or life threatening situations.
5. . Obsessive-compulsive disorder, characterized by repeated abnormal thoughts (obsessions) based on fears of contamination or impending harm, or ritualized behaviors (compulsions) such as washing the hands 50 times in a day.

Other types of anxiety exist, such as social and performance anxiety. All forms of anxiety involve feelings of fear, apprehension or tension that often bring on physical symptoms: headaches, dizziness, sweaty palms, dry mouth, racing pulse, gastrointestinal trouble, dizziness. Sleep and appetite also can be impaired, leading to other health problems. This is one area of medicine in which the link between emotional and physical health is clear.Treating Anxiety. Before diagnosing an anxiety disorder, physicians should rule out other medical conditions that may contribute to anxiety or produce similar symptoms - palpitations or shortness of breath, for example. They also should check for anxiety-related side effects from drugs. Diet should be considered, too. Once an anxiety disorder is diagnosed, several treatment options are available:

1. . Medication usually includes antidepressants or tranquilizers. Certain nutritional supplements, such as B vitamins, also may help.
2. . Psychotherapy may take several forms. In behavioral therapy, patients are gradually exposed to the source of their fears and taught to use breathing and other relaxation techniques to control their reaction. A related approach, cognitive behavioral therapy, focuses on changing thought patterns that contribute to anxiety. Psychodynamic psychotherapy seeks to uncover unconscious conflicts underlying the anxiety.
3. . Relaxation techniques can be effective in relieving the symptoms of anxiety, either alone or in combination with; other therapies.

Anxiety Research. Anxiety is a complex condition, with no single cause and a wide range of possible treatments. At VA Medical centers across the country, researchers are exploring various ways to help veterans with anxiety.

1. In Houston, psychiatrist Mark Kunik found in a clinical trial that! even a single, two-hour session of cognitive behavioral therapy in a group setting could significantly reduce anxiety symptoms in older veterans with chronic obstructive pulmonary disease.
2. In Little Rock, Ark., researchers reported that exercise could not only improve the physical functioning of older people who had suffered serious falls but ease their anxiety as well.

Nelda P. Wray, M.D., MP.H., is chief research and development officer for the Veterans Health Administration.

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