Generalized Anxiety Disorder

What is it?
Everyone has experienced feelings of apprehension and worry, as well as physical discomfort (palpitations, eadaches, sweating, chest tightness, etc.) or mental unease (difficulty concentrating, restlessness, etc.), for example, the night before an exam, during a job interview, a job change, a sports event, a major life change (marriage, divorce, etc.), or even in certain threatening situations. This fleeting agitation is tied to specific events and generally fades as soon as life gets back to normal. This is normal anxiety, a natural coping mechanism that plays a role in individual survival. The
psychological sensations a person feels constitute anxiety per se, while the physical sensations that accompany anxiety or sometimes occur without the psychological sensations are called acute anxiety.

However, when your anxiety is out of proportion to the events that cause it and many events seem to constantly make you feel anxious, we talk about generalized anxiety disorder (GAD).

This common condition affects between 5% and 10% of the population. Women are twice as likely to be affected as men. People often seek professional help as young adults but say they remember always having been anxious. In addition, they often see general practitioners or medical specialists for all sorts of nonspecific physical complaints.

A full 50% to 90% of people with GAD also suffer from another mental illness. Panic disorder, depression, and drug or alcohol abuse, in particular, are frequently associated with GAD.

What causes it?
We know that our brain cells are constantly communicating with each other through neurotransmitters. eurotransmitters regulate our emotions, movements, thoughts, cognitive functions, (memory, concentration, judgment, etc.) and survival functions (sleep, appetite, digestion, elimination, pain control, reflexes, etc.).

With GAD, the neurotransmitters' equilibrium is disturbed, but we don't know why. There is no one cause of GAD; it probably results from a combination of biological, hereditary, and environmental factors that lead to the onset of symptoms.

What can be done?
Generalized anxiety disorder is an illness and it can be treated.

Steps for action
If the above-mentioned symptoms apply to you, you can take action right away by changing your lifestyle. This will not cure generalized anxiety disorder but can help eliminate the factors that can aggravate or contribute to it. This means going to bed at a reasonable hour, exercising daily (for help with an exercise plan, visit www.0-5-30.com), and cutting down on your alcohol or drug use (www.dependances.gouv.qc.ca). People suffering from GAD often have problems with drug or alcohol abuse.

When to seek professional help
If you have been experiencing excessive anxiety for several months that is disproportionate to actual or anticipated events, accompanied by cognitive symptoms (irritability, hypervigilance, etc.) or physical symptoms (trembling, agitation, headaches, difficulty breathing, excessive sweating, palpitations, abdominal pain, sleep disturbances, etc.), you should see your family doctor or another healthcare professional. Don't wait until you are incapable of functioning
normally. A professional can determine with you whether the problem is really generalized anxiety disorder or something else and suggest a treatment adapted to your needs.

If you have suicidal thoughts or fear for your safety or that of someone you know, call Info-Santé (telephone: 811) or see a doctor IMMEDIATELY.

How it is treated
There are proven treatments for generalized anxiety disorder, and the earlier you seek help, the better the chance that treatments will be successful. In most cases, psychotherapy, medication, or a combination of the two has been found to be effective. GAD experts also generally recommend three psychotherapeutic methods:

Cognitive behavioral
Supportive
Analytical
To find a psychotherapist with the approach that's right for you and with whom you feel comfortable, ask your family doctor or contact the local health and social services center, Ordre des psychologues du Québec ww.ordrepsy.qc.ca), or Association des médecins psychiatres du Québec (www.ampq.org).

Certain antidepressants, used in this case to reduce the symptoms of anxiety rather than fight depression, help restore the balance between the neurotransmitters in the brain that regulate emotions, cognitive functions (memory, concentration, etc.), and somatic functions (pain control, heart rate, breathing, etc.). If your doctor prescribes
antidepressants, it is important to take them regularly. Be patient. Restoring balance to your brain can take time, sometimes even a few weeks. To avoid a relapse, it's very important to continue the treatment as prescribed even if you're feeling better.

The purpose of medication is to eliminate rather than just reduce or partially reduce symptoms. Sometimes, a medication can cause unwanted side effects. If so, be sure to tell your doctor. Don't stop taking your medication before talking with your doctor. Another drug may be appropriate.

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Coping with stress and anxiety - How can I let go?

Are you feeling "boxed in" coping with stress and anxiety of daily life? Perhaps your self image is out of control or not based in reality. Maybe it's time you found your own personal way to focus and relax. Read on for suggestions on finding relaxation and focus in your hectic life.

• Schedule a Time Out - A few minutes set aside for just you gives you time to step out of the situation long enough to regain perspective. One time out I like is stepping into a warm tub of water, sliding down into the water and letting the soothing comfort of a bubble bath "take me away" from the stressful situation.

• Give Yourself an Attitude Check - Take a few minutes to ask yourself, "Am I approaching life with a positive 'I can' attitude or with an attitude of negativism and defeat?" Taking an attitude check is as important to my mind as taking my pulse is to my body.

• Search for Hot Buttons - Hot Buttons are places in your life that stir up anxiety and seem to contribute to the stress in your life. Be on the lookout for the things that make you angry or frustrated immediately. These are your Hot Buttons. Once you find them, you can work through them by finding pressure points, the next item in our letting go checklist.

• Look for Revelation in Circumstances - Realize that the circumstances of life don't make you who you are; they reveal who you are. Ask yourself the tough question, "What about me is being revealed by my action/reaction to the circumstances in my life?" Be aware that the same destructive stress patterns in one person's life can be motivation to overcome difficult circumstances in the life of another person. Personal attitude could be the difference between a stressful situation and a learning one.

• Do a Control Check-Up - Take a look at who or what you trying to gain control over, and then remember this very basic truth: the only person you can have control over is yourself. I often try to gain control over circumstances and suddenly realize that the situation is a more difficult than I am able to handle. These moments become Aha! Moments: the moment you realize God may actually have the circumstances there for a reason. Are you working against God? If so, that will always be really stressful. Relieve anxiety by learning that He allows circumstances in your life for a reason. When you are able to do this, your stress will lessen considerably (Romans 8:28-29).

Have you identified the areas you need to work on? Good! After you know what they are, you can develop ways to overcome them, one by one. This includes identifying productive ways to cope with stress and trying to learn to incorporate them into your behavior. Here is a list of ways to cope with stress and anxiety that I can recommend from personal experience:

• Identify Your Unique Coping Mechanisms - Before you cope, you need to find ways that fit your personality and lifestyle. Recognize that some ways of coping -- such as by escaping the situation or running away from your problems -- are destructive in the long run. The only way to effectively coping with stress and anxiety is to face the causes of this stress.

• Change Your Focus - Get your mind off of the stress by changing your perspective on a given situation. Or go somewhere to change your surroundings.

• Make your own "God Box" - I have an old mayonnaise jar that I use for my God Box. A God Box is simply an object to remind yourself to give things over to God and not to try to handle them by yourself. You can even write your stressful situation on a slip of paper and put it inside of the box/jar. Sometimes, I need to be reminded that God doesn't need me to do His job. Try to remember not to take responsibility for the things that only He can do. I have to find a proper balance: I do my part and God does His. This takes care of a lot of my self-induced stress and anxiety overload.

• Feed Your Soul - Everyone has their very own Soul Food. Some of Soul Foods are music, the beauty of nature, inspiring stories, special relationships, a quiet place in the woods, or warmth from a gently lapping fire in the fireplace. God placed in each of us a desire for a unique something that touches and feeds our soul and draws us closer to Him so that we may regain our balance. You may need to take a vacation or getaway to regroup, dream, and allow God to refill the cup of your soul. If you remember to take a faith step toward God, be still (Psalm 46:10) and let God's presence surround you, you will really begin to relax and focus. My communication to God becomes a plea for His help. I pray "God help me to commit my stress and anxiety to You. Help me to be able to trust You to handle it. And please God, help me to accept Your way in my life."

• Seek Comfort from God's Word - Meditating on the Bible brings peace, comfort, and joy as you let God wipe your tears and calm your spirit. Here are some verses I use that especially help me: 2 Corinthians 12:9; Psalm 34:18-19, 62:5-8, 103:2-5; Philippians 4: 12-13; John 16:33.

In His Word, we learn that God may have allowed the stress into our lives to help us come closer to Him (Romans 8:28-29). This fact in itself can be comforting. You must decide whether you are able to be comforted or not. You can choose to let go of the stress and let God handle it, or you can choose to hold on and take the chance of letting the stress build up in you until it is unmanageable. Just knowing that I do have a choice helps me cope and let go of the stress and anxiety in my life.

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Coping mechanisms can be described as the sum total of ways in which we deal with minor to major stress and trauma. Some of these processes are unconscious ones, others are learned behavior, and still others are skills we consciously master in order to reduce stress, or other intense emotions like depression. Not all coping mechanisms are equally beneficial, and some can actually be very detrimental.

The body has an interior set of coping mechanisms for encountering stress. This includes the fight/flight reaction to high stress or trauma. A person perceiving stress has an automatic boost in adrenaline, prompting either action, or inaction. People have a variable level of physical reaction to different levels of stress. For some, merely getting interrupted from a task can cause an inappropriate fight/flight reaction. This can translate to “fight” mechanisms, where a person gets very angry with others for interrupting him. Alternately, flight may include physically leaving, or simply being unable to regain focus and get back on task.

Other unconscious coping strategies can include the way our minds deal with a constant barrage of stress. People in the psychiatric field suggest that mental illnesses tend to be coping mechanisms that evolve from certain stressors. For example, multiple personality disorder may result in children who are severely abused. Panic disorder may be the body’s coping mechanisms for inappropriate fight/flight reactions to minor stressors. Some mental illnesses also have a genetic basis, but stress certainly often plays a role in making these illnesses more severe.

We also learn coping mechanisms as we progress through life. Some people tend toward coping mechanisms that are helpful, while others choose defense mechanisms that can actually increase stress. The person who uses stress as a reason to exercise is learning and expressing a healthy coping mechanism. The person who turns to alcohol or drugs, eating disorders, or workaholic behavior is using coping mechanisms that are both dangerous and unhealthy.

Both children and adults can benefit from learning coping mechanisms from mental health professionals, especially when they are suffering from mental illness, or have turned to unhealthy forms of dealing with stress. In this sense, coping mechanisms are a set of practiced and learned behaviors that help us better respond to stress. We may not always be able to control the amount of adrenaline that pumps through our bodies in stressful situations, but many therapists believe we can learn to control our reaction to it.

Many times, people who experience high “fight/flight” reactions actually amp up their own stress by their coping mechanisms, creating more adrenaline boost than is needed. Learning to recognize the body’s tendency toward these highly charged states and altering behavior accordingly can reduce the length of time a person stays in the charged state, and reduce the body’s continued need to produce adrenaline to cope with danger that does not really exist. Coping mechanisms in the therapeutic sense can involve meditation, cognitive behavioral therapy, and recognition of the body’s inappropriate response to stress. These are only a few of the coping mechanisms that can be learned through therapy. They can result in fewer incidences of panic, inappropriate anger, or turning to unhelpful behaviors like using alcohol to dull stress.

People who have developed mental illness as a coping strategy benefit by learning therapeutic coping mechanisms, and by taking medication that can help reduce the symptoms of mental illness. A schizophrenic who hallucinates may be aided by the coping mechanisms provided by anti-psychotic drugs. Anti-anxiety medications can assist the person with frequent panic attacks. The gold standard in treating inappropriate coping mechanisms is to gradually replace these with therapy and medication that can help reduce inappropriate coping responses.

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Explanations - Behaviors - Coping Mechanisms

We are complex animals living complex lives in which we are not always able to cope with the difficulties that we face. As a result, we are subject to feelings of tension and stress, for example the cognitive dissonance and potential shame of doing something outside our values. To handle this discomfort we use various coping methods.

Here are coping mechanisms by type:
• Adaptive mechanisms: That offer positive help.
• Attack mechanisms: That push discomfort onto others.
• Avoidance mechanisms: That avoid the issue.
• Behavioral mechanisms: That change what we do.
• Cognitive mechanisms: That change what we think.
• Conversion mechanisms: That change one thing into another.
• Defense mechanisms: Freud's original set.
• Self-harm mechanisms: That hurt our selves.
Here is a full list of coping mechanisms:
• Acting out: not coping - giving in to the pressure to misbehave.
• Aim inhibition: lowering sights to what seems more achievable.
• Altruism: Helping others to help self.
• Attack: trying to beat down that which is threatening you.
• Avoidance: mentally or physically avoiding something that causes distress.
• Compartmentalization: separating conflicting thoughts into separated compartments.
• Compensation: making up for a weakness in one area by gain strength in another.
• Conversion: subconscious conversion of stress into physical symptoms.
• Denial: refusing to acknowledge that an event has occurred.
• Displacement: shifting of intended action to a safer target.
• Dissociation: separating oneself from parts of your life.
• Emotionality: Outbursts and extreme emotion.
• Fantasy: escaping reality into a world of possibility.
• Help-rejecting complaining: Ask for help then reject it.
• Idealization: playing up the good points and ignoring limitations of things desired.
• Identification: copying others to take on their characteristics.
• Intellectualization: avoiding emotion by focusing on facts and logic.
• Introjection: Bringing things from the outer world into the inner world.
• Passive aggression: avoiding refusal by passive avoidance.
• Performing rituals: Patterns that delay.
• Projection: seeing your own unwanted feelings in other people.
• Provocation: Get others to act so you can retaliate.
• Rationalization: creating logical reasons for bad behavior.
• Reaction Formation: avoiding something by taking a polar opposite position.
• Regression: returning to a child state to avoid problems.
• Repression: subconsciously hiding uncomfortable thoughts.
• Self-harming: physically damaging the body.
• Somatization: psychological problems turned into physical symptoms.
• Sublimation: channeling psychic energy into acceptable activities.
• Substitution: Replacing one thing with another.
• Suppression: consciously holding back unwanted urges.
• Symbolization: turning unwanted thoughts into metaphoric symbols.
• Trivializing: Making small what is really something big.
• Undoing: actions that psychologically 'undo' wrongdoings for the wrongdoer.

So what?
To help people cope, find ways to let them safely let go of the stress that they experience or gain a greater understanding of the situation.

Remember that coping actions are usually symptoms of deeper problems and addressing them directly can be ineffective or even counter-productive. The best approach is to discover the deeper cause and address this, which will hopefully then result in the coping mechanism disappearing.

Be aware of your own coping mechanisms and move to more functional means of managing stress.
If you are using deliberate theatrical methods during persuasion, feigning a coping mechanism makes it harder for the other person to broach an apparently stressful situation for you.