How to Recognize, Tackle it, and Manage it
By Francesca Sullivan
Would you consider yourself an anxious person? For many of us some degree of stress and anxiety is a part of normal life, and can even be a positive thing. Raised adrenalin levels may be useful under certain circumstances, enabling a better performance, whether at a school test, a job interview, delivering a speech in public or meeting the many challenges life throws our way. However, when feelings of anxiety become irrational or overwhelming and begin to limit and dictate to us, it might be time to seek help. Cairo West Magazine talked to Dr. Mostafa Hussein Omar, a specialist psychiatrist and member of the Royal College of Psychiatrists in the UK, at the renowned Behman hospital in Helwan, about issues around debilitating anxiety, how to recognize it and ways to tackle it.
CWM: How do you define stress and anxiety and at what point do they become mental health issues?
MO: Anxiety is a term that describes the feeling of fear that we get when we face difficult or threatening situations. It is a normal response to stress that we all experience. We all worry about many things at certain stressful or difficult times. However, when the anxiety is so intense or prolonged that it becomes a source of continuous suffering or starts to affect a person’s ability to perform their day to day activities then it is considered a psychiatric disorder.
How prevalent is this kind of disorder?
According to the most recent study published in 2009, which was researched by the National Survey of Mental Health in Egypt as part of an initiative by the General Secretariat for Mental Health and WHO, around 5% of the population has an anxiety disorder. This falls into an average world- wide statistic for which the range is from 2.5% to 10%. War, political unrest and economic crises can increase those numbers, and the study also showed that women are twice as likely to suffer from an anxiety disorder. This is a consistent finding with many surveys around the world in both developing and developed nations, though in my opinion women in Egypt do appear to suffer considerable life stresses, including financial worries, childbirth and bringing up children, FGM and its consequences, and domestic abuse. According to the survey above, ‘women bear the brunt of the adversities associated with poverty: less access to education, physical abuse from husbands, forced marriages, fewer job opportunities and, in some societies, limitation of participation in activities outside the house.’ The fact that I see more women in my clinic than men is also due to what we term ‘health seeking behaviours’; women are more likely than men to acknowledge and seek treatment for mental health issues.
Patients present various different types of anxiety disorders, the most common being obsessive-compulsive disorder (OCD), panic disorder, generalized anxiety disorder, simple phobia, social phobia and post-traumatic stress disorder.
What are the symptoms?
The most usual mental symptoms of anxiety are worrying all the time, feeling tired, irritable, sleeping badly and struggling to concentrate. As for the physical symptoms, these often include racing heartbeat, sweating, muscle tension and pains, shaking, heavy breathing, dizziness, indigestion and diarrhea.
How is it identified?
Like the majority of psychiatric disorders, anxiety disorders are diagnosed from the complaint as presented by the patient, symptoms and how these symptoms are affecting the day-to-day functioning of the person. This is done through a face-to-face interview with a psychiatrist.
Is anxiety linked to depression?
There can be definite links between the two. Anxiety may present as the primary condition, but there can be a history of depression. Conversely, suffering anxiety over a long period of time can lead to depression.
What are the main causes?
Like being dealt an unlucky hand at cards, genetics play a part in individual susceptibility to both anxiety and depression. There are some individuals who are more likely than others to become anxious, and although scientists have not yet discovered the exact gene that carries this, there is definitely a hereditary risk. However, since there are other important factors involved, psychological, environmental and social, if you have such a family history it does not necessarily mean you will inherit it, or deal with it in the same way.
Life experiences can also play an important role in the onset of anxiety, such as big changes in life circumstances; losing a job, pregnancy, or exams. Traumatic experiences, such as different types of abuse, a car crash or torture can make a person anxious for months or years after the event, even if there is no longer a source of threat.
Certain drugs can make us more anxious, either immediately, such as after taking caffeine and amphetamines, or over the long term such as the prolonged use of alcohol and tobacco products.
How can counseling help people address and resolve the issues that are creating anxiety and stress?
Treatment can be through medication or psychotherapy. Psychotherapy is an intensive talking treatment that addresses different aspects of the disorder, feelings, thoughts and behaviors. The most common form of psychotherapy for anxiety disorders is Cognitive Behavioral Therapy (CBT). It is time limited – on average once or twice a week for eight sessions – and focuses on the ‘here and now’ aspect of anxiety. In CBT the emphasis is not on the event that triggered the anxiety, but on how you think about it and deal with it in your day-to-day life. Depending on the severity of the illness, I would usually prefer to prescribe CBT, as well as other recommendations such as relaxation techniques, meditation and exercise, before resorting to drugs.
Which medications are most commonly prescribed for stress and anxiety?
Tranquilizers are the most commonly prescribed. These include the benzodiazepines, like diazepam and most sleeping tablets. They are very effective, but can be addictive, even after just a couple of weeks. Ideally, they should not be taken for longer than 2 weeks, but abuse of tranquillizers is unfortunately common.
Antidepressants: They usually take two to four weeks to make a difference. For some people they can decrease interest in sex and less often they may cause nausea, drowsiness, dizziness, dry mouth and constipation. Beta-blockers can be used in low doses to control the physical shaking of anxiety.
Can symptoms be relieved through improved nutrition, and ‘natural’ products? Which foods can help?
There is no convincing evidence that there are any particular foods that can help people with anxiety disorders. However avoiding too much caffeine or alcohol is certainly advisable. Claims are made for various herbal remedies to help with anxiety, but larger studies need to be carried out to reach conclusive evidence. Some preparations are known to be effective in treating anxiety – Valerian, for example. The problem lies in the fact it is unregulated and the exact amounts being prescribed are often not carefully monitored. Valerian can actually be potentially toxic to the liver if taken at the wrong dose.
What holistic and behavioral methods can relieve anxiety?
There is evidence that regular physical exercise; relaxation and breathing exercises can help. Also mindfulness techniques, meditation and yoga can provide some benefit.
What are your top tips for maintaining a healthy balanced lifestyle with good stress management?
Exercise often. Maintain a regular sleep routine. Don’t try to juggle too much at once. Learn to say no when you are being overloaded. Don’t be afraid to ask for help when you need it. Trying to deal with overwhelming feelings of stress and anxiety on your own will only make the problem worse.