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Fear is a natural state etched upon the emotional system of man by evolution's urge to survive. Perhaps the world of mankind has never been safe, but the level of catastrophe and potential cataclysms today are truly terrifying. The spread of technology may revolutionize the world, but it has also resulted in daunting danger. How does one who may have already struggled with pre-September anxiety cope with the unimaginable reality of the recent violence in our country? Thousands of innocent people have been assaulted, unprovoked. Our economy has been badly impacted. Terrorists attempt to scare people with violence and threat. Past experience tell us that Al Quaeda tends to perpetrate violence every 12 to 24 months. It is human nature to begin to feel safe after a period of time elapses following trauma. So in a year or so people let down vigilance and the viscous attacker strikes again.
There is a genetic potential for anxiety. Some people are born with a hypersensitive nervous system prone to neurobiological changes that transmit warning messages. Primate researchers can breed for "uptight" or "laid back" personalities. Panic involves a hyperreactive alarm system, an area of the brain that prepares the mind and body to face danger. Some panic begins with physical sensations or thoughts. The alarm center in the brain affects the sympathetic nervous system preparing us for flight or fight behaviors with increased heart rate, heightened blood pressure, and activation of transmitters and hormones. This alarm center is also connected to the part of our brain that is involved with planning and decision-making. People prone to anxiety and panic often misinterpret physical sensations and thoughts. For example, a slight physical tingling sensation may lead to catastrophic thoughts of stroke or heart failure.
Is fearfulness adaptive? How many of those with "laid back" personalities returned to their offices when the Port Authority, the management company for the world trade towers, announced in the midst of devastation that it was safe to go back to work? Is our world so unsafe? Even our children are aware. One of today's most popular children's writers spins repetitive tales of catastrophe. I recall being present at a speech given by Margaret Mead just before her death. She spoke of the sociological consequence of nuclear weaponry. Even then she believed that the human psyche would be changed forever with the awareness of the technological potential for man to destroy life on this earth. That fear is even more threatening today with the spread of nuclear weapons and the possibility for terrorists to use them.
Chronic anxiety may, indeed, spring from experience. After the tragedies of September 11th, a recent survey of American psychologists documented an increase in the numbers of patients seen for anxiety and the level of anxiety that these patients were experiencing. Since 9/11 many people have come in to therapy with fears of biological terrorism. This is especially true of those who work for public agencies. Others have suddenly found themselves afraid to fly. They often identify with the unknowing victims who were taking routine flights only to find themselves used as weapons of horror.
Technology is not the only force behind increased anxiety today. Population growth and competition for school slots, jobs, and goods are fierce pressures. People in the developed countries are frequently living in a hurried world. Money is one of the things that signifies a certain level of safety. It is the currency that purchases the provisions of life for most of us. The inequities of the distribution of goods in our country are become more discrepant. Over the past twenty years the income of families in the top 1- percent has increased 140 percent. Middle income families only increased 9 percent. Income polarization tends to breed emotional discontent. Those who do not have enough to meet their needs typically become anxious.
Once a state of anxiety becomes established as a pattern it is like a seizure. Repeated seizures can become etched in neurological memory. Being incapacitated by fear (Post Traumatic Stress is an anxiety disorder) so that we can not fully embrace our lives is clearly not adaptive. Chronic anxiety is a tortuous disease. People with anxiety disorders suffer profoundly on a regular basis. Quelling anxiety to maintain a manageable level can be difficult, and treatment must be multifaceted.
There are several medications that are effective for chronic fear. The benzodiazepines are often used at the start of treatment for acute panic or as an adjunct on an "as needed basis." These medications are quickly addictive, however, if used regularly, and they can cause rebound anxiety when discontinued. If long term medication is necessary, the SSRI's (serotonin reuptake inhibitors such as Zoloft or Prozac), can be utilized. These drugs have fewer side effects, but, unfortunately, they do not act as rapidly and can take some time to reach full therapeutic benefit.
All drugs have side effects. Many therapists use them to simply decrease unmanageable emotional states while helping patients set up new lifestyles that address their anxiety. Cognitive behavioral therapy, relaxation training and systematic desensitization are the most effective researched modalities. Good therapeutic treatment is multidimensional and involves becoming aware of catastrophic thought patterns and abandoning irrational thoughts. It is helpful to become aware of when and how traumatic memories are triggered. Strategies may be learned that quickly get one "back to the present." Avoiding anxious rumination is essential. Remember: as you think, so you feel. Thoughts affect our biochemistry, as well.
People with chronic anxiety will do well to set up viable routine life habits of thought, exercise (which, along with ambient light, can be use as a neurotransmitter self-medication), nutrition, sleep and social support. In essence, a strategic plan is formulated and is lived as a lifestyle. In most cases medication and therapy can be discontinued once changes become established as a way of intentional living. Finding peace from anxiety may indeed involve permanent adjustments in the way you think and live. Change doesn't always come easily. It takes implementation, perseverance and effort.
Many of us begin the year 2002 with mixed anticipation. Perhaps not a few of us have left 2001 with a renewed awareness of the vulnerability of life. This gives us all the more reason to assess what is truly important. Certainly, we want to establish a daily life that seizes the good and the happy. Most of us long to avoid the misery of emotional loss of perspective. Finding ourselves fearful is understandable, but establishing a lifestyle that enables us to cope well with fear is empowering.
- Dr. Linda Klaitz, Medical Psychologist
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