November 2011

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Worried Sick

Living with Anxiety Disorders

Anxiety is an uneasy feeling that something may harm you or a loved one. This feeling can be normal and sometimes even helpful. If you’re starting a new job or taking a test, it might make you more alert and ready for action. But sometimes anxiety can linger or become overwhelming. When it gets in the way of good health and peace of mind, it’s called an anxiety disorder.

If you have an anxiety disorder, you’re not alone. Each year, tens of millions of Americans of all ages suffer from long-term anxiety. Among children, anxiety disorders are the most common form of mental illness—one they may carry into adulthood. 

“Everybody has anxiety,” says Dr. Daniel Pine, an NIH neuroscientist and psychiatrist. “The tricky part is how to tell the difference between normal and abnormal anxiety.”

For those with anxiety disorders, fears, worries and anxieties can cause so much distress that they interfere with daily life. The anxiety grows out of proportion to the stressful situation or occurs when there is no real danger.

Anxiety activates the body’s stress response. Nearly all the cells, tissues and organs in your body go on high-alert. This stress response can wear your body down over time. People with chronic (long-term) anxiety have a higher risk of both physical and mental health problems. Some people visit their doctors because of headaches, racing heart or other physical complaints without realizing that these symptoms may be connected to how anxious they feel.

NIH-funded researchers are working to learn more about anxiety disorders. They have discovered that these conditions are caused by some combination of your genesStretches of DNA, a substance you inherit from your parents, that define characteristics such as how likely you are to get certain diseases. and your environment. However, the precise events that lead to anxiety disorders are still unknown. Scientists are also searching for better ways to diagnose, prevent and treat these conditions.

There are several kinds of anxiety disorders. The major types include:

  • Phobias. Intense, irrational fears triggered by things that pose little or no real danger, such as heights, dogs or spiders. Among the anxiety disorders, specific phobias are the most common.
  • Social anxiety disorder. Leads to extreme anxiety and self-consciousness in everyday social situations. Also known as social phobia.
  • Post-traumatic stress disorder. Caused by trauma. This condition leads to flashbacks, nightmares and insomnia. Often accompanied by depression or substance abuse, post-traumatic stress disorder can occur at any age, including childhood.
  • Generalized anxiety disorder. Excessive worry about a variety of everyday problems.
  • Panic disorder. Sudden attacks of terror accompanied by physical symptoms that may include heart palpitations, shortness of breath, dizziness, or abdominal distress. Panic disorder is one of the most treatable of anxiety disorders.
  • Obsessive-compulsive disorder. Persistent, upsetting thoughts (obsessions) and repetitive rituals (compulsions), like hand washing, counting, checking or cleaning. These behaviors are done in the hope of preventing the thoughts or making them go away.

Treatment for anxiety disorders usually includes both medication and cognitive behavioral therapy (CBT). CBT is a form of talk therapy. It helps people change both the thinking patterns that support their fears and the way they react to anxiety-provoking situations. Current treatments can be highly effective for most people.

Dr. Denise Chavira, a psychologist at the University of California, San Diego, works with anxious youth in underserved, rural areas. Her team is studying ways to make CBT more accessible to these children, who may have trouble getting to therapy sessions. To help make up for the lack of in-person contact, the researchers are examining telephone and self-help approaches that focus on teaching parents how to use CBT skills with their children.

In one study, the scientists are comparing CBT training delivered to parents by phone versus in-person CBT provided to anxious youth and their parents. With a therapist’s help, parents and kids create lists of anxiety-producing situations. They learn how to face their fears gradually while using CBT coping skills. Both methods encourage parents to model brave behaviors for kids, and to let kids learn how to be independent. “Some parents do this naturally, but others need some practice” says Chavira. “The phone is a less intense form of treatment, given that it only involves the parents and sessions are shorter. But even that mode can be really effective,” Chavira says.

NIH-funded researchers are also using advanced imaging tools to pinpoint the areas in the brain that underlie anxiety disorders. Still in its very early stages, this approach represents a major shift from how doctors usually diagnose mental illness, which is by looking at symptoms and behaviors. Using an imaging technique called functional MRI (fMRI), scientists are scanning the brain in action—as it thinks, remembers, feels emotion and regulates the body’s reactions to things that cause anxiety. By measuring changes in blood flow related to brain activity, fMRI scans produce full-color images of trouble spots in real time.

Dr. Sonia Bishop of the University of California-Berkeley uses fMRI to study people at high risk for anxiety disorders. Her team hopes to prevent anxiety disorders before patients enter a downward spiral. The researchers are working to develop a new type of CBT-related treatment that helps to retrain how patients regulate their emotions and attention.

Scientists are especially curious about brain regions called the amygdala and the hippocampus. The amygdala plays an important role in fear and anxiety by alerting the brain to danger. The hippocampus translates threatening events into memories. Once scientists discover if and how these areas contribute to illness, they might be able to develop better treatments.

“These disorders put a huge burden on the individual, the family and society,” Bishop says. “Anxiety disorders are one of the most common reasons that people visit their primary health care provider.”

If you are troubled by anxiety, the first person to see is your family doctor or nurse practitioner. He or she can check for any underlying physical illness or a related condition. You may be referred to a mental health specialist, who might help to identify the specific type of anxiety disorder and the appropriate treatment. With proper care, most people with anxiety disorders can lead normal, fulfilling lives.