Your response to the fear

Fear and anxiety are a normal--even essential--part of life. They prepare us for danger, creating physiological changes that enable us to effectively respond to a threat. Fear is very straightforward. It arises in response to immediate danger, so it is usually unexpected, very intense, and limited to the situation at hand. Your response to the fear, such as jumping out of the path of an oncoming car, quickly resolves the situation.

Anxiety, on the other hand, is more general and complex. It is felt in anticipation of danger, and is associated with the ability to predict, prepare for, and adapt to change. Often, it lasts a long time, and its cause remains ill-defined. For example, someone uneasy about public speaking may experience a tightness in the stomach for days before a scheduled talk.

While both fear and anxiety can provoke an arousal response, their other effects diverge. Very intense fear sometimes serves to "freeze" the body to protect it from harm, causing little or no change in heart rate and blocking the impulse to move. In anxiety, the physical changes caused by arousal lead to a second stage marked by thought patterns such as worry, dread, and mental replays of anxiety-arousing events.

Thousands of scientific studies over the past several years show that high blood pressure, ulcers, migraine headaches, strokes, alcoholism, depression, anger, fatigue, drug addiction and many other medical conditions are often due to the long-term effects of stress.

Learn common symptoms of depression

Depressed people will seem sad, or "down," or may be unable to enjoy their normal activities. They may have no appetite and lose weight (although some people eat more and gain weight when depressed). They may sleep too much or too little, have difficulty going to sleep, sleep restlessly, or awaken very early in the morning. They may speak of feeling guilty, worthless, or hopeless; they may lack energy or be jumpy and agitated. They may think about killing themselves and may even make a suicide attempt. Some depressed people have delusions (false, fixed ideas) about poverty, sickness, or sinfulness that are related to their depression. Often feelings of depression are worse at a particular time of day, for instance, every morning or every evening.

Feelings associated with anxiety include impatience, apprehensiveness, irritability, and decreased ability to concentrate. People suffering from anxiety may also worry, for no particular reason, that something bad is going to happen to themselves or their loved ones. Individuals with anxiety disorders may make such statements as: - I always thought I was just a worrier, but I would worry about things for days, to the point where I couldn't even sleep. - I had a very strong feeling of impending doom, like I was losing control in an extreme way. - I was always worried that if I didn't do certain things, my parents were going to die. - I felt as if my heart was going to explode, and I couldn't calm down.

Not everyone who is depressed has all depression's symptoms, but everyone who is depressed has at least some of them, co-existing, on most days. Depression can range in intensity from mild to severe. Depression can co-occur with other medical disorders such as cancer, heart disease, stroke, Parkinson's disease, Alzheimer's disease, and diabetes. In such cases, the depression is often overlooked and is not treated. If the depression is recognized and treated, a person's quality of life can be greatly improved.

The hallmark of this problem is chronic worry and tension with no apparent cause. People suffering from generalized anxiety disorders may worry excessively about health, money, family, or work, often anticipating disaster. Although they are usually aware that their anxiety is more intense than necessary, they can't seem to let it go. Constant worrying contributes to trouble sleeping and relaxing. People with anxiety disorders may startle easily and have trouble concentrating. Generalized anxiety disorder often leads to depression.

Causes of fears

Experts have yet to agree on the root cause of anxiety disorders. In fact, most concede that several factors may be at work in each case.

An imbalance in these neurotransmitters can cause a corresponding shift in our thoughts. But is the reverse also true? Can a determined change in our thinking alter the chemistry in the brain? Many experts are convinced this is true; and behavioral therapy aimed at changing our reactions does, in fact, cure many problems. Indeed, for some disorders, such as phobias, this type of therapy remains the most effective alternative.

1. Remember that though your feelings and symptoms are very frightening, they are not dangerous or harmful. 2. Understand that what you are experiencing is an exaggeration of your normal bodily reactions to stress. 3. Do not fight your feelings or try to wish them away. The more you are willing to face them, the less intense they will become. 4. Do not add to your panic by thinking about what "might" happen. 5. Stay in the present. Notice what is really happening to you as opposed to what you think might happen. 6. Label your fear level from zero to 10 and watch it go up and down. Notice that it does not stay at a very high level for more than a few seconds. 7. When the fear begins to trigger "what if" thinking, focus on and carry out a simple and manageable task such as counting backwards from 100 by threes or snapping a rubber band on your wrist. 8. Notice that when you stop adding frightening thoughts to your fear, it begins to fade. 9. When the fear comes, expect and accept it. Wait and give it time to pass without running away from it. 10. Be proud of the progress you make, and think about how good you will feel when you succeed this time.

Psychopharmacology and medications

It is not entirely clear why psychotropic medications work; yet, it appears that they reestablish balance within the chemistry of the brain. Behavior is determined through messages transmitted within the brain from one nerve cell to another through various chemicals. These chemicals are called neurotransmitters. Through the millions of nerve cells within the brain, chemicals trigger memories, sleep patterns, perceptions, feelings, moods and thoughts. The electric current that carries the messages are received by nerve ends, called synapses, which then release the neurotransmitter. These chemicals, in turn, propagate the message by stimulating the next nerves in line to send on the electrical message. Once used, the neurotransmitter chemical is returned and stored in the nerve end. This recycling process is called reuptake. When this signaling process goes askew, the effects are seen in a person's behavior and experienced in his emotions, perceptions, sensations, and ideas.

Although there are numerous chemicals that perform vital functions within the brain, three basic chemicals, or neurotransmitters, seem most critical in regulating this process and maintaining balance: serotonin, which is related to anxiety, depression, and aggression; dopamine, which affects reality perception and pleasurable experiences; and norepinephrine, which affects attention, concentration, and mood.

Health care professional really may help

Among the professionals who can help are psychiatrists, psychologists, social workers, and counselors. However, it's best to look for a professional who has specialized training in cognitive-behavioral therapy and/or behavioral therapy, as appropriate, and who is open to the use of medications, should they be needed.

You may be concerned about paying for treatment for an anxiety disorder. If you belong to a Health Maintenance Organization or have some other kind of health insurance, the costs of your treatment may be fully or partially covered. There are also public mental health centers that charge people according to how much they are able to pay. If you are on public assistance, you may be able to get care through your state Medicaid plan.

Terms explaining

Anxiety

• A state of uneasiness and apprehension, as about future uncertainties.


• Worry or tension in response to real or imagined stress, danger, or dreaded situations. Physical reactions such as fast pulse, sweating, trembling, fatigue, and weakness may accompany anxiety.

Anxiety disorder

• A psychiatric disorder involving the presence of anxiety that is so intense or so frequently present that it causes difficulty or distress for the individual.

Anxiety disorders

• Any of various disorders in which anxiety is either the primary disturbance or is the result of confronting a feared situation or object; they include obsessive-compulsive disorder and posttraumatic stress disorder.

Fear

• Fear is an unpleasant feeling of perceived risk or danger, whether it be real or imagined.

Depression

• In psychiatry, a symptom of mood disorder characterized by intense feelings of loss, sadness, hopelessness, failure, and rejection.

Mental health

• A state of emotional and psychological well-being in which an individual is able to use his or her cognitive and emotional capabilities, function in society, and meet the ordinary demands of everyday life.


• The psychological state of someone who is functioning at a satisfactory level of emotional and behavioral adjustment.

Stress

• A state of extreme difficulty, pressure, or strain.


• A physical and psychological response that results from being exposed to a demand or pressure.

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