People who constantly worry or complain about how anxious they are can become partially emotionally immobilized and have great difficulty negotiating their lives. Like rust on an iron pipe, it will erode the quality of our lives. Sigmund Freud called this impediment to growth an anxiety neurosis. Others have the ability to take direct action by dealing with the event or object that is causing the stressful or anxious reaction. They employ methods to diffuse or tone down the intensity. Anxiety can be described as an autonomic or automatic response that is not under our direct control, when we are exposed to a present or future stressful event. We begin to experience an uncomfortable sensation within our own skin. The physical presence is akin to a low voltage of electrical current pulsing throughout our bodies. It is usually triggered by a seemingly ever-present issue that remains with us until that which is worrying us is resolved. Worry becomes a label applied to an actual physiological arousal that begins in the thinking part of our brains. We interpret information received by any one of our senses and the resulting response will determine whether we feel safe and calm or unsafe and anxious. The process of stimuli input, information processing, perception, interpretation and cortical response is completed in milliseconds by our central nervous system, composed of our brain and spinal cord. Our spinal cord is bicameral, meaning it is divided into two sections, the sympathetic, and the parasympathetic nervous systems. The former is our alarm system, alerting us to take action, or to do something about our unsafe or anxious state. The latter calms us down when we are no longer perceiving ourselves as threatened.
When “The Rust” Becomes Corrosive
Anxiety or ‘rust’ can reach a level where it becomes corrosive, meaning that it can develop into a more serious problem or in psychological terms a diagnosis. Think about sitting in your car, starting it, placing it in neutral, while you compress the gas pedal and run the engine as if you were going 80 miles an hour, but standing still. If you keep your “pedal to the metal,” eventually some part of the engine or transmission will break down. As humans we are kind of the same way. If we keep running our “engines” at high speed, we will also begin to break down psychologically and eventually physically. Anxiety is akin to energy. The diagnostic and statistical manual of mental disorders (DSM-IV TR 2000), says that we qualify for the diagnosis of general anxiety disorder (GAD), if we have excessive anxiety and worry about a number of distinctive events or activities that is debilitating over a period of at least 6 months. Epidemiologists say that the prevalence rate in our population for generalized anxiety disorder is about 3%. That is a lot of people running around excessively anxious and worried. Generalized anxiety disorder seems to run in families, and research (twin studies) indicate that heritability estimates are between 30-40%. Concordance rates for identical twins (MZ) are significantly higher than fraternal twins (DZ) for GAD. Cognitive or information processing factors also play a role. People who feel less able to control events are more likely to be anxious and develop generalized anxiety disorder. Can Corrosive “Rust” Be Stopped?
Prior to ascertaining what type of intervention is appropriate, two questions have to be considered. First, is the anxiety specific to a current stressful situation or situations? And second, is the anxiety more generalized and diffuse experienced most of the time, as in generalized anxiety disorder (GAD)? Situation specific anxiety has a better prognosis than the longer term generalized anxiety disorder. Therefore, an accurate diagnosis of the presenting problem(s) is important. Treatment is available in both cases, and in two forms, psychotherapeutic and psychopharmacological, or a combination of both. Cognitive behavior therapy is effective when the person is going through a particularly stressful time and does not have the requisite cognitive skills to cope with life stressors. Examples would be the death of a love one, divorce, loss of a job, etc. In this case the symptoms are usually of a transient nature and will slowly diminish as life circumstances begin to improve. Highly skilled cognitive-behavioral therapists have at their command many types of evidenced based treatments and interventions to aid their clients recover from the debilitating effects of traumatic events. When people are overwhelmed by their symptoms it may be difficult for them to concentrate on cognitive-behavioral interventions alone. At that point it may be indicated to refer the client to a psychiatric colleague for a prescription of an anti-anxiety medication. When there are concomitant symptoms of depression, as there are in many cases an anti-depressant may be the treatment of choice. A few of the newer anti-depressants are also effective in treating the anxiety that often accompanies depression. The treating psychiatrist and the client will usually make that decision based upon the presenting symptoms. The literature shows that in many cases a combination of psychotherapy and psychopharmacology will yield the best outcomes.
Generalized Anxiety Disorder (GAD)
Generalized anxiety disorder as a diagnosis contains the word “generalized,” which presents a more complex clinical picture. The client with this diagnosis may report that their anxiety is more diffuse and general, out of proportion to the normal pressures of life. Whereas anxiety at low levels may be adaptive, these clients experience it at a level that is maladaptive and associated with pessimism and negative self-evaluation. Treatment usually consists of relaxation training and cognitive therapy. Clients can learn to recognize the faulty logic behind their worry and rumination. Another method is to have the patient consider the worst-case scenarios, which helps them to identify exaggerated worry. This is known as decatastrophisizing. Psychopharmacological interventions usually rely on SSRIs as the first line treatment for anxiety disorders, as they have similar therapeutic benefits to anti-anxiety medications and fewer side effects. SSRIs are preferred over anti-anxiety medications due to the latter’s serious problems with addiction and withdrawal once the client discontinues use. There is one other medication to consider, BuSpar, which affects serotonin transmission and is used in the treatment of generalized anxiety disorder. Responses to this medication vary greatly and remain inconclusive.
The clinician must also be aware of clients’ tendencies to self-medicate with readily available legal and illegal drugs. It is not uncommon for clients to present with comorbid anxiety and substance use disorders.
In conclusion, we are all faced with stressful life events, yet some of us due to particular vulnerabilities are prone to develop these disorders and fall prey to “anxiety, the rust of life.”
Robert M. Lichtman, PhD, LMHC, CASAC, FAPA, is an Adjunct Associate Professor in the Department of Forensic Psychology at John Jay College of Criminal Justice. He is a Clinical Member of the American Association for Marriage & Family Counseling, and a Fellow of the American Psychotherapy Association. He specializes in Relationships, Mental Illness & Substance Abuse, Forensics, Terrorism, Violence & Aggression.