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Taming Anxiety – A Two-Edged Sword

Anxiety disorders often begin in childhood and may last through the adult years.The are the most common psychiatric disorders in children. They often occur in combination with other psychiatric syndromes such as Bi-polar Disorder and Attention Deficit Hyperactivity Disorder.  They include: Obsessive-Compulsive Disorder, Social Anxiety Disorder, Specific Phobia, Generalized Anxiety Disorder, Post-Traumatic Stress Disorder, and Panic Disorder.

Most theories include the likelihood of a genetic predisposition to anxiety. With Obsessive-Compulsive Disorder, for example, there is a higher probability that both members of a pair of identical (monzygotic) twins will be affected than with non-identical (dizygotic) twins.There is a higher incidence in first degree relatives (7%) than in the general population (2.5%).  The neuroanatomy of Panic Disorder is based upon our understanding of the primitive fear response, involving the amygdala, a brain structure that coordinates input from Synapse xt the sensory thalamus, the brain stem, and higher level cortical regions.  It is hypothsized that misinterpretation of sensory information results in hyperexcitability of the nervous system.  This faulty information is stored in the hipcampus, where it is resistant to extinction, and makes the individual susceptible to intense anxiety attacks with repeated stimulation.

Two biochemical mechanisms have been identified.  A naturally occurring chemical, gamma-aminobutyric acid (GABA) reduces brain excitability by facilitating the absorption of chloride inions into nerve cells.  Panic is hypothesized to be related to either an excess or deficit in GABA. An effective class of medications for anxiety, Benzodiazepines, bind to the cell receptors to which GABA molecules normally attach. Xanex is one example of a Benzodiazapan.

Serotnin is a neurotransmitter that facilitates the transmssion of nerve impulses at the synapse between nerve endings.  Serotonin is secreted before each nerve impulse and then re-absorbed after it. passes. It is thought that in anxiety conditions there is a depletion of the amount of serotonin at the synapse.  A class of drugs called Specific Serotonin Re-uptake Inhibitors (SSRIs) work to increase the concentration of Serotonin at the synapse. Although SSRIs were initially used for depression, there is increasing evidence that that may also be helpful in reducing anxiety.

Traditionally psychotherapy was an intensive procedure designed to analyze personality structure, defenses, underlying conflicts, and early childhood experiences in order to help the individual gain insight as to the origin of his problems.  Many therapists still accept this “pschodynamic” approach to treatment.  In more recent years some therpists have elected to focus directly upon presenting symptoms, including anxiety, based upon the assumption that many symptoms and behavior represent a psychosocial learning process that can be extinguished.  One method, called systematic desenitization, was introduced by  South African psychiatrist , Joseph Wolpe.  The method consists of teaching patients deep muscle relaxation and then systematically introducing stimuli that arouse fear or anxiety in small doses, much as an allergist desensitizes allergies.  Stimuli can be in the form of  imagined scenes or the real object or situation. The method has proven useful in treating specific fears, generalized anxiety, insomnia, and pain management.  Another type of desensitization (Eye Movement Desensitization and Reprocessing (EMDR) uses back and forth movements of the eyes while thinking a frightening thought.