Roger is a 34-year-old software engineer, who recently started his first job. He has always been an anxious person and describes himself as being on edge all the time and his wife feels he unnecessarily worries all the time. Every morning he wakes up dreading going to work, playing in his mind all the things that could go wrong. Traffic, angry boss, power cut, failed presentation, smelly socks and what not. This is often associated with physical sensations of uneasiness, abdominal discomfort and constant muscle tension. These thoughts detract his attention away from his daily work and interactions and his productivity and relations suffer. He also has episodes of overwhelming fear associated with feelings of doom and loss of control, which occurs out of the blue and are accompanied by chest discomfort, tremors, palpitations and sweating. These episodes are usually followed by a medical consult which reveals no abnormal findings and ends with reassurance from a cardiologist that his body is fine and that he should not be so stressed out.

The word anxiety is derived from the Latin word anxietas (which means to choke, throttle, trouble and upset) and encompasses behavioral, affective and cognitive responses to anticipated / perceived danger. While fear is an intense emotional state which is activated in response to objective danger.

Thus anxiety is essentially made of anticipatory “what ifs”.

What if, the test has only questions I do not know?

What if, my child falls ill at school

What if, I get a flat tyre on the way to work?

What if, someone laughs at me?

What if? Someone is hiding in the closet?

Fear and anxiety have strong physiological correlates, remember the last time you were afraid, your heart was pounding, hands trembling, head heavy and that you were drenched in sweat.

A recent study estimated that 20% of the population sufferers from issues related to anxiety disorders. Not including panic attacks. Out of which around 6% suffer from generalized anxiety and around 4.2% from phobias. 20% of the world's population grossly translates to 1.5 billion people!

How do anxiety disorders develop?

Biologically, the seat of emotion in the human brain lies in the limbic system, a network of interconnected structures responsible for emotion, motivation, memory and learning. The limbic system includes structures like the amydala, hippocampus and the hypothalamus connecting it to endocrine system and the autonomous nervous system (controls breathing, heart rate and functions that occur without conscious effort). Anxiety is thus associated with autonomous activation such as increased heart rate, tremors, sweating, palpitations and bowel movements.

Anxiety disorders are also caused by abnormalities in neurotransmitter substances such as serotonin and nor adrenaline

When the body perceives an adverse threat (irrespective of the likelihood of the threat occurring) as real, it activates the autonomic nervous system, pumping the blood to the organs that are essential to either flight or flee from the threat. This leads to physical symptoms (like palpitations), that can worsen anxiety.

Anxiety is reinforced by avoidance. Every time one avoids doing things one is anxious of, there is a temporary relief from the distressing feelings. For example a person with claustrophobia (fear of being in closed spaces) avoids going on a lift, at that moment the threat is neutralized and the behavior that neutralized the threat (avoidance) is reinforced. So the next time avoidance would seem like an effective escape strategy. The only problem is avoidance will reinforce itself. So when one is faced with the situation wherein he “has” to get on an elevator how do you think it would be? Avoiding speaking in front of a crowd will worsen the anxiety exponentially till it becomes a phobia.

How is Anxiety treated?

1) Behavioral therapy – Behavioral therapy includes the extinguishing of aberrant learnt responses and the reinforcement of optimal coping strategies. For example, people suffering from a fear of cats may slowly be exposed to stimuli that remind them of a cat in a graduated manner, until the anxiety response is unlearned.

2) Medications – Benzodiazepines are a class of psychoactive medication that is used as sedatives and hypnotics, which are very effective in controlling anxiety. A number of antidepressants are also very effective in treating anxiety and panic.

Your doctor may choose either of the above or a combination of both in the management of anxiety.

3) Other techniques and self-help measures – Mindfulness, yoga and exercise are great ways in which one can break the anxiety response. Mindfulness is an ancient Buddhist technique wherein you can learn to live in the present and question the validity of your thoughts. It has been proven to help with anxiety and a number of other mental illnesses. People often find their own ways to cope, but avoidance is to be avoided. If an anxiety provoking situation is encountered, its is almost always better to end, rather than avoid.

It is very important to recognize anxiety when it becomes that disruptive emotion which keeps you on edge or that which makes you skip things you like doing. It is essential that you know that you are not alone in this battle and there is help available.