Basic forms
- Generalized anxiety disorder: constant worry about different things - health, loved ones, work; tension, inability to relax, sleep disturbances
- Panic disorder: sudden attacks of intense fear with bodily symptoms that reach a peak within 10 minutes; between attacks - fear of their repetition
- Social anxiety disorder: fear of evaluation and judgment, avoidance of public situations
- Specific phobias: fear of heights, closed spaces, flying, injections
- Agoraphobia: fear of situations from which it is difficult to get out - transport, crowds, queues; often associated with panic disorder
Bodily manifestations
- Palpitations, feeling of interruptions
- Lack of air, feeling of suffocation, lump in throat
- Dizziness, instability, feeling of unreality
- Sweating, shaking, heat waves or chills
- Numbness and tingling in the hands and around the mouth
- Nausea, abdominal discomfort, frequent urination
- Muscle tension, headaches
Ощущения при панической атаке реальны и объясняются выбросом адреналина. Но они не опасны: паническая атака не приводит к инфаркту, инсульту, удушью или потере рассудка, и всегда заканчивается сама.
Why Avoidance Makes It Worse
A key mechanism that maintains anxiety disorders is avoidance. The person did not take the subway, anxiety decreased, the brain “remembered”: the subway is dangerous, but avoidance saved the day. Next time the fear is stronger, and the list of avoided situations grows.
- This is how agoraphobia is formed: first transport, then shops, then leaving the house
- The same applies to “rescue behavior”: always carry a pill with you, walk only with an accompanying person, constantly check your pulse
- A gradual, measured return to avoided situations helps break the circle - the basis of behavioral therapy
Treatment
- Cognitive behavioral therapy is the first choice treatment with the best evidence; involves thought work and gradual exposure
- Antidepressants of the SSRI and SNRI group are basic drug therapy; effect in 2–4 weeks, course for at least 6–12 months
- At the beginning of treatment, a temporary increase in anxiety is possible - the doctor usually starts with small doses
- Benzodiazepine tranquilizers - only for a short course: with long-term use, dependence is formed
- Regular aerobic exercise has been proven to reduce anxiety levels
- Limit caffeine, energy drinks, alcohol and nicotine
- Normalization of sleep and breathing techniques with extended exhalation
Self-help during an attack
- Напомнить себе: это паническая атака, она достигнет пика и пройдёт за несколько минут, она не опасна.
- Замедлить дыхание: вдох на 4 счёта, выдох на 6–8. Именно длинный выдох снижает возбуждение.
- Не убегать of ситуации — остаться до снижения тревоги, это ослабляет закрепление страха.
- Заземлиться: назвать 5 предметов, которые видите, 4 звука, 3 ощущения в теле.
- После приступа записать, что предшествовало и какие мысли были — материал для работы с психотерапевтом.