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Anxiety
& Tackling it With Meditation
The term ‘anxiety disorders’ describe a number of
common mental health conditions. Anxiety disorders differ from what is regarded
as developmentally normal fear or anxiety, by being excessive or persistent
beyond developmentally appropriate ages.
In the first chapter and discourse of the Bhagavad
Gita we find a classic example of anxiety when Arjun flinches on seeing his
kinsmen arrayed for the epic battle. Arjun said: “Seeing these, my kinsmen, O
Krishna, arrayed, eager to fight, my limbs fail and my mouth is parched, my
body quivers and my hairs stand on end! The Gandiva (bow) slips from my hand,
and my skin burns all over; I am unable even to stand, and my mind is reeling.”
Having spoken with such despondency in the midst of the battlefield, Arjun cast
aside his bow and arrow, and sat down on the seat of the chariot, his mind
overwhelmed with sorrow.
What are Anxiety Disorders?
The term ‘anxiety disorders’ describe a number of
common mental health conditions. Anxiety disorders differ from what is regarded
as developmentally normal fear or anxiety, by being excessive or persistent
beyond developmentally appropriate ages. The symptoms are often persistent
across various situations impacting on all aspects of an individual’s life.
Many of these disorders start in early childhood and tend to persist if not
treated.
What is Anxiety?
Anxiety as a word is derived from the Greek word,
meaning ‘to press tight’ or ‘to strangle’. The word anxiety may be described as
a continual and often irrational feeling of arousal, discomfort and tension,
usually without any justifiable cause. Anxiety is a response to a threat that
is generally unknown, internal, vague, or conflicted; whereas fear is defined
as a response to a known, external, definite, or non-conflictual threat.
Mark Twain said, “I’m an old man and have known a
great many troubles, but most of them never happened.”
The feeling of anxiety is a normal human emotion
that everyone experiences. Many people feel anxious or nervous when faced with
a work problem or before an exam. In some situations, anxiety can even be
essential to your survival. For example, if you were standing on a footpath and
a car swerved towards you, you would immediately sense danger, feel alarmed and
jump back to avoid the car. This normal anxiety response, called the “fight or
flight” response, is what prompts you to either fight or flee from danger. In
most cases of normal anxiety we can identify a cause of stress and the reaction
is reasonable and appropriate.
Anxiety disorders are different, however. They can
cause such distress that they interfere with a person’s ability to lead a
normal life.
Classification of Anxiety Disorders
About one in four people have an anxiety disorder
that needs treatment at some time in their life.
Anxiety disorders take a variety of forms. Recent
American psychiatric classification of anxiety disorders have listed the
following clinical disorders:
Separation Anxiety Disorder: Where the individual
is fearful of separation from an attached person to the degree that is
developmentally inappropriate. He or she has constant fear that harm or
separation from the significant attachment figure would occur. For example, a
child persistently refusing to separate from his/her mother to go to school.
Selective Mutism: Consistent failure to speak in
social settings in which there is an expectation to speak (e.g. at school),
even though the individual speaks in other situations. This behaviour tends to
affect various aspects of the individual’s life.
Specific Phobia: Individuals are fearful, anxious
or avoidant of an object or situation. This includes fear of animals, heights,
seeing blood and injections, confined spaces and many others. The word phobia
is derived from the Greek word ‘phobos’, the name of the Greek god who provoked
panic and flight in his enemies.
Social Anxiety Disorder: Individuals are fearful,
anxious or avoidant of social interactions and situations that will involve
possibility of scrutiny or humiliation. Examples include having a conversation,
meeting unfamiliar people, eating and public speaking.
Panic Disorder: Individuals experience recurrent
panic attacks and are persistently concerned of having another panic attack or
develop maladaptive behaviour to prevent further panic attacks. A panic attack
is a sudden feeling of intense terror which may occur in certain situations or
for no apparent reason. Symptoms include shortness of breath, dizziness, rapid
heartbeat, choking and nausea. The person may feel they are going crazy, about
to have a heart attack or die. The word panic is derived from the Greek word
‘Pan’. Pan is the Greek god who is the originator of sudden and unexplainable
terror.
Agoraphobia: Individuals develop fear or anxiety
of certain environmental situations for fear of not being able to escape or
help not being available in the event of having a panic attack. They may avoid
using public transport, being in crowds, malls, or even leaving home.
Generalized Anxiety Disorder: This is excessive
anxiety and worry about almost everything including work, finances and school.
An individual finds it difficult to control the worry and it is often
accompanied with physical symptoms such as headaches, neck spasms, mind going
blank and insomnia.
Thus, there are a range of anxiety disorders,
characterized by persistent, unreasonable fears about general or specific
events. Anxiety disorders which are untreated can lead to depression and other
long term physical and psychological problems.
It is also important to note that many medical
diseases, alcohol and other substances can cause anxiety-like symptoms. These
underlying causes need to be treated first to relieve the individual of
anxiety. If the anxiety does not subside, then the anxiety needs to be treated
as well.
Conditions such as obsessive compulsive disorder
(OCD) and post-traumatic stress disorder (PTSD) were previously also
incorporated into the anxiety disorder classification. Since 2013, they are
considered in different categories.
What causes Anxiety?
Some reasons include:
A learnt response over time – such as learning to
fear something after having seen others being fearful of it
Personality types – some people are naturally more
anxious than others
Stressful or traumatic life events
A family history of anxiety disorders
Childhood development issues
Alcohol, medications or illicit substances
And other medical or psychiatric problems.
Equally important may be the person’s general
level of anxiety, beliefs and attitudes the individual may hold about herself /
himself and how the world should be. Such problems often begin as a young adult
and may be triggered by one or more major events in a person’s life.
There are a range of psychological therapies for
anxiety, aimed at helping the person control their arousal levels and manage
their panic attacks.
What are the Symptoms?
Anxiety comes in many forms and the symptoms can
vary greatly from person to person.
A person may experience:
Fearful anticipation and muscle tension
Irritability and sleep disturbances
Noise sensitiveness and restlessness
Worrying thoughts and difficulty concentrating.
The fear may be accompanied by tightness of the
chest, palpitations, tingling and ‘butterflies’ in the stomach.
As symptoms intensify they can include feelings of
breathlessness, dizziness, sweating and trembling, racing heart, dry mouth,
chills or hot flushes, choking, nausea, stomach upset, and pins and needles in
the hands.
Some people feel like they are going to lose
control or die and may feel as if they are having a heart attack, among other
medical disorders.
There may also be general symptoms of tiredness,
headaches, loss of appetite, constipation or even diahorrea.
The person will avoid the situation that is
predisposing to the stress. An extreme case is where the person is terrified of
all forms of social contact, even to the point of being unable to leave home.
The person is aware of the irrational and excessive nature of his or her fears.
When he or she comes for treatment, he or she says, “I know my fears are
unreasonable, but I just can’t seem to stop them.”
As described in the opening paragraph to the
article, upon Arjun asking Bhagwan Krishna to drive his chariot into the midst
of the two armies, he is faced with the brutal reality of having to go into
battle with his kinsman, elders and guru. The enormity of the sinful task that
he has to undertake overwhelms him. Thus, Arjun experiences the physical symptoms,
mental anguish and emotional turmoil in keeping with a person unable to
function due to the severity of his anxiety.
In reply, Bhagwan Krishna explains to Arjun the
futility of his anxiety and the epic poem, the Bhagavad Gita, is revealed to us
all. Krishna tells him it is not sinful for him to do his duty as a Kshatriya –
it is a war between dharma and adharma. The Bhagavad Gita contains probably the
first literary description of the symptoms of anxiety and more significantly,
Bhagwan Krishna’s oration on the Kurukshetra battlefield, describes its
holistic treatment.
Treatment
In every case, there is a need for careful medical
assessment, as it is important to exclude an underlying medical cause to the
anxiety. Once an anxiety disorder is diagnosed, medication together with
psychological treatments may be prescribed. Psychological treatment such as
relaxation training, meditation, biofeedback and stress management can help.
One of the most effective forms of treatment is Cognitive Behavioural Therapy (CBT).
Cognitive Behavioural Therapy
Specific Drug Therapy
People suffering from panic attacks as part of an
anxiety disorder may be helped with tranquillizers, anti-depressants and other
classes of drugs.
Tranquilizers are usually only prescribed in
specific cases, to control such unpleasant side effects of anxiety as panic
attacks or high levels of anxiety or arousal.
Education and Psychological Therapy
There are a range of psychological therapies for
anxiety, aimed at helping the person control their arousal levels and manage
their panic attacks.
Education, therapy and counselling can help them
understand their thoughts, emotions and behaviour and give them new ways to
deal with their anxiety.
Counselling can also assist the person to stop
drug or alcohol use, resolve life stresses, and develop overall better coping
skills. Education and counselling help the person reduce stress, resolve
conflicts, manage their life more effectively, develop new ways of thinking
about themselves and the world, and develop new ways of enjoying activities.
Part of the treatment may involve helping the
person avoid family conflicts and developing ways of using their family as a
means of support and encouragement.
Cognitive behavioural therapy (CBT) is established
as the first-choice psychological treatment for anxiety disorders. CBT helps
patients identify, question and correct their tendencies to overestimate danger
and their perceived inability to cope with danger. Patients recognize that
their thoughts, attitudes and beliefs can generate and maintain anxious states.
Common distortions in thinking are identified and restructured. This leads to
modifications in behaviour, thus alleviating anxiety.
Bhagwan Swaminarayan through the Vachanamrut sets
forth a philosophy that shifts the reader’s thinking, attitudes and belief
systems. Distorted perceptions are set straight, thus a cognitive shift is
achieved in the study of the Vachanamrut. This is further reinforced by
Gunatitanand Swami’s Swamini Vato which reveals further eternal truths. Both
treatises, although written over 200 years ago, are only now being understood
by Western thinking.
What is interesting in the BAPS Sanstha is that
through Pramukh Swami Maharaj we see a living embodiment of anxiety-free
behaviour. These are captured in his responses to the challenging experiences
he has had:
Being turned back at Nairobi airport (1974)
Being falsely set up to be arrested (1977)
Upon experiencing a heart attack (1983)
Awaiting a cardiac procedure (1998)
Gandhinagar Akshardham attack (2002).
Pramukh Swami Maharaj demonstrates the optimal
cognitive mindset of a person who in spite of facing high anxiety situations
and circumstances maintains a calm, collected and balanced state. This is
further reflected in his exemplary behaviour amidst the many worldly stressors
that Swami is surrounded by. Swami additionally teaches how to proactively deal
with stress through his words and deeds. He has advised those individuals who
have asked, in thousands of letters, how to deal with specific stressors and
problems they were facing.
Other simple techniques to cope with anxiety:
Meditation, mindfulness, muscle relaxation, yoga
and spiritual reading of God or guru’s divine stories
Exercise daily – this releases ‘feel good’ and
naturally uplifting hormones called endorphins
Talk about your worries with someone you trust
Find balance between work, hobbies, family and
social life, and try to remove factors that cause stress
Learn deep-breathing techniques to help deal with
a panic attack
Eat a vegetarian diet
No alcohol, cigarettes and drugs
Reduce tea and coffee intake and stop if possible
Develop a good sleep pattern
Build your self-esteem and keep a positive outlook
on life.
Case Studies
Mr. S has had recurrent, unexpected panic attacks
for the past three years: “They started one Monday morning when I was caught in
the traffic on my way to work. I began to shake, feel dizzy, and could not
concentrate on the road. I became short of breath and had to open the car
windows. My chest was pounding and I felt that I was going to pass out. I
thought I was having a heart attack. I thought I was going to faint or worse,
die! I started to sweat and shake all over. I managed to stop on the side and
called my son. He insisted that we go to a hospital, but I refused as I felt
fine. However, I began to experience these attacks in shopping malls, and even
on the train. I spent most of my day worrying and waiting for the next attack.
I avoided going out as I would not be sure if I would have an attack. I
eventually agreed to see a doctor, who ruled out any medical cause to the
symptoms. That was a great relief as I really felt that there was something
wrong with my heart. He referred me to a psychiatrist who initiated medication
and also referred me for psychotherapy. I have since improved and these attacks
are very infrequent, if any.”
Mr. J, a businessman, who commuted to his
workplace in South Mumbai daily by train for years, came to the clinic
accompanied by his wife. He reported that the company he had worked for
diligently for the last 22 years had retrenched numerous staff early this year.
Although he had not been retrenched, there was nervous anticipation that there
were going to be future retrenchments and this had created more uncertainty in
his workplace.
For the last three months he noticed a tightness
in his chest and felt like he was being smothered by a pillow while he was
travelling on the overcrowded peak morning Western Line to work. These attacks
had gradually got worse and he had had to get off the train on many occassions
prior to reaching his final destination at Churchgate Station. He had begun to
take the very early train to work or the very late train from work to avoid the
crowds and also would stand near the exit of the train so that he could escape
from the crowds if he felt the need.
However, his anxiety became worse and he had begun
to feel anxious even when he ventured out into the overcrowded Mumbai streets
and bazaars making him eventually housebound. Family functions like weddings,
where there were large crowds, also became challenging. He constantly needed a
family member or friend to accompany him outside.
Mr. J was initiated on
medication and psychotherapy. He also learnt breathing techniques and started
the practice of meditation and yoga to assist in relaxing. He showed gradual
improvement and is now able to leave his home alone and
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