« I’m the one you can’t see, I’m the one you can’t hear, I’m hidden on the verge of tears, I’m the queen of drama » are the words of the artist Apple to describe the anxiety in his eponymous song. Worrying about a new situation, we all do it. Fear is an instinctive reaction that protects us, allows us to anticipate and face dangers. It takes on its full meaning in a context of occasional stress or real threat by helping us to better face them. But sometimes it has nothing to do with reality, becomes autonomous and takes on disproportionate proportions. Anxiety, this emotion yet so specific to human beings, then becomes pathological. The red line is crossed when the threat seems to be everywhere, when anxious thoughts run amok without reason managing to relativize them. One reproach at work and we fear losing our jobs. Banal headaches and we already see ourselves with a serious illness. For others, it’s the idea of getting in an elevator or being in the crowd that triggers a cold sweat…
Unhealthy anxiety is based on catastrophic beliefs: “It is a tendency to imagine the worst, to overestimate the danger and to underestimate its capacities to cope”, explains Professor Guido Bondolfi, chief medical officer of the Service Liaison Psychiatry and Crisis Intervention and the Anxiety Disorders Program of Geneva University Hospitals (HUG).
At the biological level, anxiety is explained by a disruption of the alarm system in the brain, in particular of the amygdala, the seat of fear: « Like the immune system of the allergic person who goes into overdrive for almost nothing (pollen, cat hair, etc.), the fear system of anxious people is out of order and clearly does too much. Their tolerance threshold is low due to a hypersensitive amygdala which reacts (or anticipates) in an exaggerated way to an object, a situation, an animal”, describes the psychiatrist in a work * devoted to this subject.
different faces
A unique expertise
The anxiety disorders program of the University Hospitals of Geneva (HUG) is unique in French-speaking Switzerland. Patients are referred to it by their doctor or a psychologist. All benefit from an in-depth assessment through interviews, diagnostic scales and specific questionnaires. When the diagnosis is made, medicopsychiatric care is offered: individual or group psychotherapy, pharmacological treatment if necessary and groups based on mindfulness. “We have a competent network of psychiatrists and psychologists to whom we refer some of the patients after an assessment,” says Professor Bondolfi, head doctor of the Liaison Psychiatry and Crisis Intervention Service and the Anxiety Disorders Program. of the HUGs. The therapeutic palette is wide and the chances of getting out of it are real. “Anxiety disorders are treated effectively today, but there is no complete cure. The approach consists above all in alleviating the symptoms and helping to live with them,” notes the psychiatrist. It’s about putting anxiety in its place: “It can be part of the decor, but should not be at the center of life”, concludes Paolo Cordera, psychologist within the HUG program.
Anxiety is recognized as a real disorder, listed in international diagnostic classifications. “Anxiety disorders are characterized by a triad of physical, psychological and behavioral symptoms,” says Dr. Andrea Cremasco, head of clinic in the anxiety disorders program at HUG. On a physical level, anxiety can manifest as a lump in the stomach, recurrent headaches, chronic low back pain, etc. It can take on several faces and thus give rise to different diagnoses (read further). Diffuse, dull and permanent in generalized anxiety disorder (GAD), it is centered on a specific object in phobias or obsessive compulsive disorders (OCD) (fear of germs, for example). But it can also be sudden and brutal, as in a panic attack: « An anxiety-provoking situation triggers a procession of reactions (palpitations, tachycardia, spike in blood pressure, dizziness, blurred vision, tingling, cramps, digestive disorders), felt so intense that the person goes to the emergency room. There is then an awareness of the psychic origin of these symptoms, ”continues the psychiatrist.
A vicious circle
Anthony, 29: ‘I’m not anxious, but I go through moments of anxiety’
“I started the anxiety-focused mindfulness meditation program last October. In the group there are people of all ages who have a completely normal life. Before, I felt like I was the only one with panic disorder. But as our stories overlap, it brings a bit of normality to what is happening within us. There is a meditation part and a cognitive and behavioral therapy part. The alliance of the two, with the synergy of the group in addition, really makes progress. Our instructor, Frédérique Tettamanti, has an incredible ability to listen. The connection with her helps a lot. Meditation is very complementary to psychotherapy. It is a magical tool that allows you to deal with anxiety, but which is also part of a healthy lifestyle.
This program has given me a lot of confidence in my ability to “be with” feelings of anxiety and not see it as something maddening anymore. I know my body and my feelings better. I no longer feel overwhelmed, I manage to cut it short. I’ve learned that I’m not anxious, but I do go through times of anxiety. It’s very different. »
* Mindfulness Based Intervention for Anxiety.
On the psychic level, anxiety, especially when it is generalized, is “a real intolerance to uncertainty”, describes Professor Bondolfi. It is expressed by hypervigilance at all times and leads to behaviors of safety and avoidance. For fear of not being able to measure up or being crushed by their fear, people with anxiety resort to all sorts of strategies: delegating a presentation in public, giving up going out of their homes if they are not accompanied or develop rituals to reassure themselves, for example. Even if they are aware of it, it is difficult for them to extricate themselves from this functioning: “They know that they are exaggerating, but they cannot do otherwise. They then become prisoners of their anxiety,” comments Professor Bondolfi. If, in the short term, avoidance strategies calm anxieties, in the long term, they restrict freedom. As for anxious ruminations, which are a vain attempt to keep control over events, they are, in the long run, a source of exhaustion. Little by little, a whole life is conditioned by the disorder.
The entourage, very often, is not spared: « When a person prevents his whole family from going on vacation for fear of flying or that he embarks his loved ones in systems of rituals and checks, he takes the others hostage and in spite of herself becomes a tyrant”, warns Professor Bondolfi. But above all, adds Paolo Cordera, psychologist within the HUG program: “By avoiding the situations that we fear, we risk moving away from ourselves and from what matters to us. For example, people with social phobia avoid social contact when they actually value it.
By dint of renunciations, a feeling of devaluation sets in. When anxiety becomes pain, it makes us irritable, it prevents us from living and working normally, we must ask for help. A lack of care can lead to a chronicization of the disorders, even to depression.
Mapping of anxiety disorders
Social phobia – 2 to 4% of the population: It is the apprehension of ordinary social situations, such as telephoning in public, being watched having dinner in a restaurant, speaking in front of others, etc. This fear of ridicule and judgment can lead to the adoption of safety behaviors to avoid self-attention. The risk of depression and alcohol addiction to disinhibit oneself is high.
Generalized Anxiety Disorder (GAD) – 4-6% of the population: The person relentlessly apprehends future events, whatever they may be. Deaf to reassuring signals, she sinks into anxious anticipation. Her negative projections and her constant need for reassurance exhaust her and those around her. GAD is often accompanied by muscle tension, restlessness, insomnia, irritability, ruminations, etc.
Phobias – 10% of the population: Fear attaches to a specific object (cats, spiders, dogs, clowns, needles, etc.). Anxiety, irrational, may or may not be related to a traumatic experience. The confrontation with the feared situation, or its anticipation, causes symptoms similar to those of a panic attack.
Panic attack and panic disorder – 2-3% of the population: This state of very intense fear (acceleration of heart and respiratory rates, sweating, etc.) occurs suddenly, for no apparent reason, and is accompanied by a feeling of near death and loss of self-control (cotton legs, dizziness , etc.), in the absence of vital danger. Everyone can have a panic attack at some point in their life. When these attacks are repeated, it is called panic disorder.
Obsessive Compulsive Disorders (OCD) – 2-3% of the population: In an attempt to calm the distressing thoughts, people with OCD feel compelled to perform rituals and checks that in reality bring them no relief, since they repeat them over and over again. It is an uncertainty that goes around in circles, fueled by a sense of exaggerated responsibility.
_____
#Understanding #anxiety #manage
