Anxiety: What you should know and how to treat it

It's the middle of the night and your heart is pounding in your chest. Nagging thoughts replay in your mind, coupled with a sense of impending doom. While you've been worried about things before, this is another level of dread that seems to demand all of your energy and attention.

What exactly is the cause of this horrible feeling that you wouldn't wish on your worst enemy?

“Excessive rumination, worry, and avoidance behaviours are hallmarks of anxiety disorders,” says Dr. Gillian Kirsh, Clinical Psychologist at North York General Hospital. “We all experience worry or nerves at times, but when these feelings start interfering with the quality of our life, it is time to seek treatment. Anxiety tends to spiral when left untreated, and can lead to depressive symptoms if it persists too long.” Dr. Gillian Kirsh, Clinical Psychologist, North York General Hospital
Dr. Gillian Kirsh, Clinical Psychologist, North York General Hospital
Anxiety finds its root in the body's evolutionary fight-or-flight reaction — an often life-saving reflex originally designed to prepare us to confront or run from a real threat or danger. In today's society, it can be triggered by modern-day stressors such as worries about our job, health or family life. This worrying isn't necessarily helpful. On overdrive, our fight-or-flight response can lead to a whole host of anxiety symptoms such as panic attacks, phobias, and obsessive-compulsive symptoms. Anxiety includes physical, psychological, and cognitive symptoms. Physical symptoms can range from fatigue to muscle tension, sweating, and rapid heartbeat.

The root causes of an anxiety disorder can often be difficult to pinpoint. “It's not a reflection of lack of courage or inner strength,” says Dr. Kirsh. “Some people are more prone to anxiety than others, just like others are more prone to certain physical conditions. Frequently, the instinctive response to an anxious reaction is to avoid the situation. However, avoidance is like oxygen to a fire for anxiety."
There are many effective treatment strategies available for anxiety disorders.
Whatever your symptoms, it's important to know that there are effective treatment strategies available.
  • The first thing to do is to speak with a health care professional. “Voicing your concerns can be the most difficult, but most important first step,” says Dr. Kirsh. “Once you do that, you can move forward with treatment. While each case is different, research shows that a combination of therapy and medication can often be highly effective for treating anxiety disorders.”

  • One evidence-based approach is Cognitive Behaviour Therapy (CBT), which focuses on the links between thoughts, feelings, and behaviours. Understanding what type of thoughts lead to anxiety-provoking feelings and avoidance behaviours, and how to dispel those maladaptive coping strategies, has proven to be beneficial. “We don't often realize how much power our internal monologue and obsessive thoughts impact us because they are so engrained in our daily lives,” explains Dr. Kirsh, “but once we replace irrational beliefs with rational ones, we can begin to feel better right away.”

  • Medication, such as selective serotonin reuptake inhibitors (SSRIs), can also help to reduce feelings of worry and anxiety. SSRIs work by blocking reabsorption of serotonin in the brain, thereby increasing serotonin levels. Other medications, such as serotonin-norepinephrine reuptake inhibitors (SNRIs), increase levels of both serotonin and norepinephrine.
Whatever your course of treatment, Dr. Kirsh stresses an open mind, patience, and willingness to try techniques suggested by your psychotherapist. It is important to find a therapist with whom you feel comfortable. “Anxiety disorders are common and we have come a long way in learning how to manage them,” she says. “Know that you are not alone and there are many different courses and options for treatment.”
February 6, 2019

This article first appeared in the February 2019 issue of The Pulse, North York General Hospital's community newsletter. Subscribe to receive 10 issues per year.

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