Preface to “Anxiety Protocol”

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Anxiety-Protocol-2There’s a quiet revolution occurring in psychiatry. The mental illness burden is felt worldwide, yet psychiatry has not been able to help millions of people who suffer from mental illness, as access to psychiatry and mental health services is at a crisis (Fields and Corbett-Dooren, 2014). Psychiatry is fast becoming trivialized due to its inability to deliver treatment to the population. But gone are the days when doctors had the monopoly on medical knowledge. With the advent of the internet, people can now research their symptoms, possible illnesses, and treatment options before even seeing the doctor. When people are suffering from mental illness and can’t access psychiatry, they still need help. As a result, people naturally look to the internet and research their ailments online. For people with anxiety, this book, Anxiety Protocol, and its affiliated website, AnxietyBoss.com, represent a new option for those who suffer from anxiety but are not able to receive help. This is an online solution that is based on self-help and natural remedies for anxiety. It is for the newer generations who are not pill-poppers and seek a natural, self-reliant way of getting rid of their anxiety. It is for the new generation who are more health-conscious and looking for healthy living options to treat and prevent anxiety. What we offer here is the latest evidence-based program to help eradicate your anxiety. These are evidence-based services and products that have research showing they are effective at eradicating anxiety…all from the comfort of your laptop, tablet, or smartphone. Imagine: a treatment for anxiety that does not involve going to a doctor’s office or hospital. This is the quiet revolution in psychiatry, where a treatment for anxiety can be effective and delivered without a doctor or therapist, without prescription medications (that have multiple and sometimes severe side effects). Certainly, I’m not advocating you ditch your psychiatrist if you already have one. If you have severe anxiety disorder, then you do need to see a psychiatrist. However, for milder forms of anxiety, this online, natural, and self-reliant intervention will signal the beginning of the quiet revolution in psychiatry, where treatment is delivered virtually, online.

But psychiatry still has much to offer people who have mental illness. These are important and exciting times for the profession, as it tries to figure out the neurobiological underpinnings of mental illness. Currently, clinical psychiatry does not have objective, biological tests to help confirm mental illness. Rather, mental illness is diagnosed based on history and clinical presentation. However, psychiatry is fast becoming a specialty of medicine based on the brain. The mind, and the various problems and illnesses that are from disorders of the mind, can basically be explained at a molecular level, with neurons communicating with each other via synapses, and these synapses connect to one another via neurotransmitters. These neurotransmitters are the chemicals which carry out the message between neurons, and the receptors of these neurotransmitters are the targets of the psychiatric medications prescribed for mental illness…this is the so-called “chemical imbalance” of mental illness. But mental illness is much more complex than a chemical imbalance. In the brain on a macro level, mental processes have specific circuitry, which connect different parts of the brain, and this circuitry is comprised of the neurons which conduct the message between brain areas. Functional neuroimaging is already revealing preliminary evidence that mental illness is associated with disruptions of these brain circuits, and that treatment can normalize these circuits. It is hypothesized that psychotherapy and other alternative treatments can also normalize these disruptions in brain circuitry. In addition to neuroimaging research, genetics research is on the verge of finding the constellation of genes responsible for transmission of mental illness in families. In the next few years, psychiatry should have objective, biological tests to help diagnose mental illness, and cures may be possible. These are exciting times in psychiatry, given it is at the brink of finding the cause (and cure) of mental illness.

On the other hand, it is also the worst of times for psychiatry, given so many people with mental illness suffer without treatment. This book, Anxiety Protocol, and its affiliated website, AnxietyBoss.com, respond to those individuals who often go unheard. It’s been developed to deliver treatment online and virtually. It is our sincere hope that we can reach the millions who suffer from anxiety, and provide them with a natural, online, and self-reliant solution to their ailment.

 

Carlo Carandang, MD

Author, Anxiety Protocol

September 2014

Anxiety Disorders

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Anxiety disorders are characterized by extreme fear, nervousness, or worry on exposure to a feared stimulus, which can be an object, person, or situation. Fear is differentiated from anxiety, in that fear is a reaction to a current stimulus, whereas anxiety is fear of some future stimulus or anticipation of one. Anxiety becomes a problem when one becomes fearful, nervous, or worried out of proportion to the feared stimulus, or becomes nervous or worried about some future stimulus or anticipated event.

Fear is a normal response, and is a necessary component of survival. When presented with danger in the environment, a physiological reaction is triggered where adrenaline is released into the bloodstream. Adrenaline is a fear-response hormone which causes several physical changes in the body, including increased heart rate, increased rate of breathing, and dilated pupils. In addition, there is shunting of the blood flow from the digestive system and the skin to the skeletal muscles, which can be felt as having the “butterflies” in the stomach or having numbness and tingling sensations of the extremities. These physical changes allow the person to prepare to fight the danger, or to run from it, the so-called “fight-or-flight” response. The increased heart rate and breathing rate allows the blood to supply more oxygen to the skeletal muscles needed to fight or run, and the blood shunting to the skeletal muscles further aids this process. The dilated pupils allows for improved vision to assess the danger, and the brain becomes more alert and hypervigilant for danger, allowing one to scan their environment in order to deal with the external danger. However, this fear response goes awry when one starts to anticipate danger, or starts to have thoughts about events which overestimate the danger and underestimate one’s ability to cope with the danger. In this situation, the fear response is heightened by one’s thoughts about the event or future event, where the overestimation of danger and underestimating of one’s coping leads to anxiety. Unfortunately, the body perceives fear and anxiety the same way, where the adrenaline response is triggered with either fear or anxiety. So when one has anxiety, the fight-or-flight response is activated, and serves no purpose as the danger is more in one’s head and the way they think or give meaning to the situation.

Anxiety becomes an anxiety disorder when the anxiety symptoms cause impairment of functioning in relationships and work/school, and the person has significant distress and is unable to control the anxiety. The major anxiety disorders include generalized anxiety disorder, specific phobia, social phobia, panic disorder, post traumatic stress disorder, and obsessive compulsive disorder. Other anxiety disorders include substance induced anxiety disorder, anxiety due to a general medical condition, acute stress disorder, adjustment disorder with anxiety, separation anxiety disorder, and selective mutism. Each disorder is associated with a specific core anxiety symptom:

  • Generalized anxiety disorder- generalized worries
  • Specific phobia- fear of an object or situation (ie fear of heights)
  • Social phobia- fear of social scrutiny (ie stage fright)
  • Panic disorder- panic attacks
  • Post traumatic stress disorder- flashbacks and nightmares of trauma
  • Obsessive compulsive disorder- intrusive thoughts and ritualistic behaviors

Anxiety treatment involves psychotherapy, with cognitive behavioral therapy (CBT) having the most evidence for efficacy. CBT works on the premise that events or situations do not directly cause the anxiety; rather, the thoughts we have or the meaning we give the events causes the anxiety. CBT works by identifying the maladaptive thoughts, working on more adaptive thoughts, and suppressing/distancing oneself from the maladaptive thinking. In addition, CBT addresses the avoidant behaviors which serve to sustain the anxiety over the long term; this can be a difficult task, as the avoidant behaviors serve to relieve anxiety in the short term. Other forms of psychotherapy include depth or insight oriented psychotherapy, which addresses the causes and the proximal determinants of the anxiety. If psychotherapy is not effective, or if the anxiety symptoms are severe, then pharmacotherapy with anxiety medications can be considered after a psychiatric assessment. Other treatments for anxiety include self-help treatments, natural supplements, and alternative interventions for anxiety like exercise, meditation, and relaxation. Please see AnxietyBoss.com for more information and help on anxiety.

photo credit: PracticalCures Anxiety via photopin (license)