Introduction
Patients with generalized anxiety disorders worry excessively about everything all the time.
If this persists for more than at least 6 months, the psychiatrist or psychologist will diagnose this disorder. The following conditions also have to be met:
1. the patient cannot control the worry.
2. at least three items of the following list accompany the anxiety or worry: restlessness – tiring easily – being irritated – muscle tension – sleep disturbance – concentration problem.
3. the worries and anxiety may not be perceived by the patient as”excessive”, but on further questioning it is clear that it interferes significantly with normal functioning in social situations, at work and in other areas important to the patient’s normal life activities.
4. the disorder is not due to another mental illness and is not due to a substance or medical illness.
5. the intensity, the time it lasts and the frequency of attacks are completely out of proportion with how a normal person would react to the feared event. Patients with generalized anxiety disorder tend to worry about ordinary day to day responsibilities at home or at work.
Symptoms of generalized anxiety disorder
Patients with this disorder will complain about muscular symptoms such as a feeling shaky, trembling, pain, soreness and twitching. Patients may somatisize and complain of various symptoms such as cold hands and feet, dryness in the mouth, diarrhea or nausea, a lump in the throat, frequency of urination, sweating or clammy hands. Sometimes the doctor might find in addition a medical condition such as irritable bowel syndrome or tension type headaches. To complicate matters, generalized anxiety disorder can occur together with other psychiatric conditions such as:
1. a mood disorders such as dysthymic or major depressive disorder
2. panic disorder, social phobia or specific phobia
3. a substance-related disorder (hypnotic, alcohol, anxiolytic dependency).
Generalized Anxiety Disorders
Treatment of generalized anxiety disorder
Many treatment attempts with counseling have not yielded the desired good outcome. It seems to be easier to simply put the patient on a small dosage of an anxiolytic medication such as benzodiazepines like alprazolam (brand name: Xanax), clonazepam (brand names: Rivotril, Klonopin), diazepam (brand names: Valium, Valrelease, Zetran), lorazepam( brand name: Ativan) and oxazepam (brand name: Serax).
They are all effective in controlling acute anxiety and generalized anxiety disorder. However, on the long term there can be a problem with dependency on the medication with these anxiolytics. Usually the literature quotes high dropout rates for people with generalized anxiety disorder( Ref. 7). These authors found that the presence of general anxiety disorder, when it coexisted with obsessive-compulsive disorder, was the reason for dropping out of the behavior therapy for the obsessive-compulsive disorder. However, it appears that with a combination of cognitive therapy and behavior therapy the presence of generalized anxiety disorder in the treatment of social phobia had a very good treatment outcome as the authors of Ref. 8 showed. Analytical hypnotherapy can be used as another tool to help patients with generalized anxiety disorder, but not every patient will get into a good trance.
Once patients get into a good trance and feel comfortable talking under hypnosis or communicating with ideomotor signals (usually finger signals), then the root of the psychiatric problem in the subconscious memory stores can be quickly identified and alternative ways of coping with different life situations can be suggested. It is often rewarding for the patient as well as the therapist to see that only a few hypnotherapy sessions can solve a seemingly hopeless anxiety problem in a short period of time. Once successfully treated with hypnotherapy the patient stays symptom free from then onwards. This is so, because the subconscious pattern of thinking that was disorderly before is normalized after the successful treatment. Cognitive and behavioral therapy is useful as well, but it does not seem to penetrate as deep into the subconscious (where the fears and anxieties are located) as hypnotherapy does (Ref.5, 6 and 9).
References
1. Dr. David Burns: “Feeling good –The new mood therapy”, Avon Books, New York,1992.
2. Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition, (DSM-IV),American Psychiatric Association, Washington,DC,1994.
3. Dr. Shaila Misri at the 46th St. Paul’s Hosp. Cont. Educ. Conference, November 2000, Vancouver/B.C./ Canada.
4. JM Loftis et al. J Neurochem 2000 Nov 75(5): 2040-2050.
5. B. Zilbergeld et al. “Hypnosis – Questions& Answers”, W.W. Norton & Co, New York,1986: 307-312.
6. MH Erickson & EL Rossi:”Hypnotherapy, an exploratory casebook”, Irvington Publishers Inc., New York, 1979: chapter 8, 314-363.
7. G Steketee et al. Compr Psychiatry 2001 Jan 42(1): 76-86.
8. DS Mennin et al. J Anxiety Disord 2000 July-Aug 14(4): 325- 343.
9. J Hartland: “Medical &Dental Hypnosis and its Clinical Applications”, 2nd edition, Bailliere Tindall,London,1982, page: 326-336.
