Updated: Mar 27
Understanding and treating anxiety can often improve the outcome of chronic disease
With headlines warning us of international terrorism, global warming, and economic uncertainty, we're all likely to be a little more anxious these days. As an everyday emotion, anxiety — the "fight or flight" response — can be a good thing, prompting us to take extra precautions. But when anxiety persists in the absence of a need to fight or flee, it can not only interfere with our daily lives but also undermine our physical health. Evidence suggests that people with anxiety disorders are at greater risk of developing a number of chronic medical conditions. They may also have more severe symptoms and a greater risk of death when they become ill.
Anxiety is a reaction to stress that has both psychological and physical features. The feeling is thought to arise in the amygdala, a brain region that governs many intense emotional responses. As neurotransmitters carry the impulse to the sympathetic nervous system, heart and breathing rates increase, muscles tense, and blood flow is diverted from the abdominal organs to the brain. In the short term, anxiety prepares us to confront a crisis by putting the body on alert. But its physical effects can be counterproductive, causing light-headedness, nausea, diarrhea, and frequent urination. And when it persists, anxiety can take a toll on our mental and physical health.
Anxiety as an illness
Research on the physiology of anxiety-related illness is still young, but there's growing evidence of mutual influence between emotions and physical functioning. Yet anxiety often goes unidentified as a source of other disorders, such as substance abuse or physical addiction, that can result from attempts to quell feelings of anxiety. And it's often overlooked in the myriad symptoms of chronic conditions like irritable bowel syndrome (IBS) or migraine headaches.
Nearly two-thirds of the estimated 40 million adults with anxiety disorders are women. What people with these disorders have in common is unwarranted fear or distress that interferes with daily life (see chart). Anxiety also plays a role in somatic symptom disorder, which is characterized by physical symptoms such as pain, nausea, weakness, or dizziness that have no apparent physical cause.
Anxiety has been implicated in several chronic physical illnesses, including heart disease, chronic respiratory disorders, and gastrointestinal conditions. When people with these disorders have untreated anxiety, the disease itself is more difficult to treat, their physical symptoms often become worse, and in some cases, they die sooner.
Physical benefits of treating anxiety
Therapies that have been successful in treating anxiety disorders can ease the symptoms of chronic gastrointestinal and respiratory diseases. These therapies may have an important role in preventing and treating heart disease. These are the best-studied approaches:
Cognitive-behavioral therapy. The cognitive component helps people identify and avoid thoughts that generate anxiety, and the behavioral part helps them learn how to react differently to anxiety-provoking situations. The specifics of the treatment depend on the type of anxiety. For example, patients with a generalized anxiety disorder or panic disorder may be asked to examine their lives for habits and patterns that foster a sense of dread. They may also be taught relaxation techniques to diminish anxiety. Patients with OCD characterized by excessive washing may be asked to dirty their hands and wait with a therapist for increasingly longer intervals before cleaning up.
Psycho-dynamic psychotherapy. Anxiety is often triggered by a deep-seated emotional conflict or a traumatic experience that can sometimes be explored and resolved through psychotherapy. In the first randomized controlled clinical trial comparing relaxation therapy to psycho-dynamic psychotherapy (focused talk therapy), clinician-researchers at Columbia University in New York found that panic-disorder patients treated with psychodynamic therapy had significantly fewer symptoms and functioned better socially than those who underwent relaxation therapy. Nearly three-quarters of the psychotherapy group responded to treatment compared with only 39% of the relaxation-therapy group.
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