Fear and Anxiety
by Timothy R. Jennings
Anxiety disorders, not to be confused with the general fear and anxiety experienced by all humans, represent a wide range of disorders characterized by disabling fear, worry, dread, and anxiety. â€œAnxiety disorders represent a malfunction of the system for activating and terminating a defensive responseâ€¦symptoms are expressions of the excessive functioning of a personâ€™s systemsâ€ (Beck, Emery, & Greenberg, 2005, p. 22). Mental symptoms of anxiety include anticipation, apprehension, rumination, intrusive thoughts and images, confusion, disassociation, feeling as if things are not real, or fear of dying or going crazy. Physical symptoms include muscle tension, nausea, diarrhea, dizziness, racing heart, chest pain or pressure, rapid or difficult breathing, tremulousness, numbness, tingling, and hot flashes and sweating.
Anxiety disorders are the most common of all mental illnesses. The lifetime prevalence of the United States adult population is 28.8%, and the one-year prevalence is 18.1%. Women are 60% more likely than men to experience anxiety disorders; blacks are 20% less likely and Hispanics 30% less likely than Caucasians to experience anxiety disorders. Only 36.9% of individuals with anxiety disorder receive any treatment, and only 12.7% receive minimally adequate treatment (National Institutes of Mental Health [NIMH], 2005).
Multiple reliable screening tools are available to assist in identifying individuals likely to be suffering with anxiety disorders, but the diagnosis requires careful clinical interviewing and history taking. The exact specific diagnostic criteria for each disorder can be found in the Diagnostic and Statistical Manual of Mental Disorders (DSM-IV-TR). Following is an overview of the various anxiety disorders and their general symptoms.
Generalized anxiety is a state of excessive worry, anxiety, or apprehension most days for a six-month period. A diagnosis requires that the anxiety interferes with functioning and has at least three of the following symptoms:
feeling wound-up, tense, or restless
easily becoming fatigued or worn-out
significant tension in muscles
difficulty with sleep
Panic disorder is characterized by recurrent panic attacks, worry and fear of the future, and four or more of the following:
palpitations, pounding heart, or accelerated heart rate
sweating panic attacks (sudden onset of severe fear) that interfere with functioning
trembling or shaking
shortness of breath or sensation of smothering
feeling of choking
chest pain or discomfort
nausea or abdominal distress
feeling dizzy, unsteady, lightheaded, or faint
feelings of unreality (derealization) or being detached from oneself (depersonalization)
fear of losing control or going crazy
fear of dying
numbness or tingling sensations (paresthesias)
chills or hot flushes
Acute stress disorder occurs in the aftermath of a traumatic event and causes significant functional impairment. It is associated with reexperiencing the traumatic event, avoidance of stimuli that remind the person of the event, emotional numbing, feeling as if things are not real, and marked anxiety. The condition persists for at least two days but no longer than four weeks and occurs within four weeks of the trauma.
Posttraumatic stress disorder is a chronic anxiety disorder that is experienced in the aftermath of trauma in which the trauma is reexperienced through intrusive thoughts, nightmares, and flashbacks, causing disturbance of function. This disorder is associated with impaired relationships, emotional numbing, loss of interest, sense of foreshortened future, increased startle response, sleep disturbance, hypervigilance, impaired concentration, and irritable or angry outbursts.
Specific phobias are marked and unreasonable fears that are associated with a specific object or experience and that interfere with functioning.
Social phobia is marked and unreasonable fear of social or performance situations. The person recognizes the fear is unreasonable but avoids settings that would induce the fear.
Obsessive-compulsive disorder is an anxiety disorder of either obsessions or compulsions that cause marked distress, are time consuming, and interfere with functioning.
Obsessions are recurrent and persistent impulses or images that are intrusive and inappropriate and that cause marked anxiety or distress. These are irrational and out of proportion to routine life stressors. Persons with this disorder will attempt to resist or neutralize these obsessions with some thought or action and recognize these thoughts and their response as products of their own mind.
Compulsions are repetitive behaviors (e.g., hand washing, ordering, checking) or mental acts (e.g. praying, counting, repeating words silently) in which the person feels driven to perform in response to an obsession. The person recognizes that the obsessions and compulsions are excessive or unreasonable.
Anxiety disorders are generally treated in the outpatient setting and usually involve a combination of psychotherapy and medication. Psychotherapies are integral to treating anxiety disorders, with cognitive behavior therapy demonstrating the most robust improvements.
Medications are also beneficial. The medications most commonly used in anxiety disorders are the serotonin reuptake inhibitors (fluoxetine, sertraline, paroxetine, citalopram, escitalopram), the serotonin norepinephrine reuptake inhibitors (venlafexine, desvenlafexine, duloxetine), the benzodiazapines (diazepam, alprazolam, clonazepam, etc.), and in severe cases, the antipsychotic medications. Studies have shown that a combination of psychotherapy and pharmacotherapy achieve better outcomes than either modality by itself.
Other factors that contribute to anxiety include sleep deprivation, caffeine and illegal drugs, family conflict, belief in angry and punishing God concepts, and living a self-centered life. Thus, addressing each of these factors will result in anxiety reduction.
Biblical and Spiritual Issues.
As soon as Adam and Eve sinned, they ran and hid because they were afraid. Fear and anxiety are part of the infection of sin. Fear is the primary motivator toward selfish behavior and is the engine that drives the â€œsurvival of the fittestâ€ instinct. This instinct is known in Scripture as the law of sin and death (Rom. 7:23â€“8:2) and is overcome in our lives by Christâ€™s work to restore Godâ€™s law of love into our hearts (Heb. 8:10). As Scripture says, â€œPerfect love drives out fearâ€ (1 Jn. 4:18).
Research has shown that meditation and prayer can offer effective treatments for anxiety (Lee, Zaharlick, & Akers, 2011). Furthermore, recent advances in neuroscience have confirmed the biblical wisdom that love eradicates fear. The part of the brain in which fear is generated is called the amygdala, whereas the part of the brain in which we experience altruistic love, compassion, empathy, and sympathy is called the anterior cingulate cortex (ACC). Dr. Newberg at the University of Pennsylvania has shown that when individuals aged 60 to 65 meditated 12 minutes a day for 30 days on a God of love, they experience growth in the ACC as measured by MRI brain scans, reductions in heart rate and blood pressure, and improvement in memory testing. Meditating on any other God concept, such as an angry, wrathful, distant, or punitive god did not result in these positive outcomes (Newberg & Waldman, 2009). This means that growth in the ACC from meditating on a God of love calms and reduces the firing of the brainâ€™s fear center (the amygdala).
Because of sin, when we encounter a stressful experience, the brainâ€™s alarm circuitry (amygdala) will fire, causing the release of adrenalin and stress hormones (glucocorticoids). During an immediate threat, such as a dog attack, this system quickly prepares the body for survival. It will shunt blood out of the digestive organs and into the muscles; cause the heart rate and respirations to increase, increasing oxygen and blood flow to the muscles; dilate the pupils; raise the blood pressure; and alert the brain. We become more aroused and prepared for action. The glucocorticoids cause glucose to be dumped into the bloodstream for energy to either fight or take flight. Additionally, the immune system is primed, or turned on, and inflammatory cytokines are released in order to protect the body against any bacterial or viral invaders if the skin should be pierced.
All of this sounds rather good in the short term, but when one stays stressed, these pathways stay activated and cause significant problems to the body and brain. Anxiety disorders â€œreflect either the hyperactivity of the behavioral system or else its inhibition,â€ neither of which is healthy long-term (Beck et al., 2005, p. 24). Chronic anxiety results in increased risk of obesity, heart attack, stroke, diabetes mellitus, bone loss, and mental illnesses, such as depression (Gorman, 2004).
American Psychiatric Association. (2000). Diagnostic and Statistical Manual of Mental Disorders (4th ed., text rev.). Washington, DC: Author.
Beck, A. T., Emery, G., & Greenberg, R. (2005). Anxiety Disorders and Phobias: A Cognitive Perspective. Cambridge, MA: Basic Books.
Gorman, J. L. (Ed.). (2004). Fear and Anxiety: Benefits of Translational Research. Washington, DC: American Psychiatric Association.
Lee, M. Y., Zaharlick, A., & Akers, D. (2011). Meditation and treatment of female trauma survivors of interpersonal abuses: Utilizing clientsâ€™ strength. Families in Society, 92(1), 41-49.
National Institutes of Mental Health. (2005). Statistics: Any Anxiety Disorder Among Adults. Retrieved from http://www.nimh.nih.gov/statistics/1ANYANX_ADULT.shtml
Newberg, A., & Waldman, M. R. (2009). How God Changes Your Brain: Breakthrough Findings from a Leading Neuroscientist. New York, NY: Ballantine Books.