When our ancient ancestors still lived in caves, fear was an emotional response which was necessary for survival.
If one day a caveman went to his favourite watering hole and there were fresh paw prints from a pack of sabre-toothed tigers, his fear response would send adrenaline coursing through his veins making him alert, focused and ready for spear-related action.
Before his next visit, he would probably feel stressed and nervous about encountering the predatory cats - his fear and anxiety, which are natural emotional responses to stress, would help him deal with this.
However, if from then on, everytime he thought about going to get water, our caveman got so stressed and anxious that he would feel nauseous and get a tummy ache and coudn't bring himself to set foot outside his cave, he would be suffering from an anxiety disorder.
If a few days later, he was happily building a fire outside his cave when he suddenly felt dizzy, found it hard to breathe and had strong sharp pains in his chest, this would be a panic attack.
According to Jared Alden, psychotherapist at the German Centre for Neurology and Psychiatry in Dubai Healthcare City (www.gnp-dubai.com), we evolved to experience fear so that we would react to imminent dangers, but now, we often ignore these emotional signals.
"Nobody ever died from a panic attack, or from anxiety. But ultimately our physical, mental and emotional health will be affected if we are suffering from stress and anxiety. It may not shorten the quantity of your life, but it will affect the quality of your life."
Daily fear
Sangeeta D'Souza, 33, says that although she has only had one panic attack in her life, anxiety is a constant companion. "I am a very anxious person. I don't know why - nobody else in my family is like this. I feel anxious about everything - it is something I experience every day."
For Sangeeta, it started when she was about eight or nine and seems to be getting progressively worse as she gets older. "It stops me from doing a lot of things - if we go to a water park, I have to stand at the bottom of the slide so I can make sure my friends come out of there alive. If we go to the beach, I think there is going to be a tsunami. The worst thing for me though is flying."
Sangeeta's life-long fear of flying eventually culminated in a panic attack two years ago, the night before she was due to fly to Sri Lanka.
She says, "I was nervous about the flight in the days leading up to it, but the day before, I started saying to my husband, ‘If I get on that plane, I will not be coming back.' We went out for dinner and on the way home I was thinking, ‘This is the last time I will see Shaikh Zayed Road.' I couldn't sleep that night for the longest time, and then woke up at two in the morning. I was shaking and screaming and crying. It was horrible - I was just so convinced that the plane would crash and I would die. I was out of control - my husband couldn't even help me. I eventually started to calm down when my husband told me that it was OK and I didn't have to get on the plane. The whole thing lasted about an hour."
Shortly after her panic attack, Sangeeta went for hypnotherapy, which helped with the flying for a little while, but she thinks the effects are wearing off and that the fear is creeping back in.
"I know that this is something I need help with and something I need to get under control."
Anxiety is not only linked with panic attacks, but with other negative emotional and mental states too. Dubai-based psychologist Rudolf Stockling works as a therapist at Lexicon Reading Centre (www.lexiconreadingcenter.org), which specialises in dyslexia and other learning issues.
He says, "Anxiety and depression are very closely related. Sometimes depression can help ease anxiety because the patient has lower energy levels in general, so less energy to worry. The difference between them is that anxiety is characterised by the physical agitation and symptoms. But they both relate to a person's perception of events."
Anxiety and panic attacks can also lead to phobias, says Stockling. This is because when you have a panic attack, your mind may build an association between the situation or environment with that feeling of fear.
So, if you are in a car when you have a panic attack - even if the panic attack has nothing to do with the car or driving - your mind may associate the fear with being in a car and you may feel anxious about getting into a car again. If allowed to fester, this could develop into a full blown irrational fear of cars, which would be debilitating. "It's like state-dependent learning," says Stockling, "where memories of similar experiences and past panic attacks will come back and cause another attack in the same situation."
Anxiety types
There are many different types of anxiety disorder. The five most common ones are Generalised Anxiety Disorder (GAD), Obsessive-Compulsive Disorder, Panic Disorder, Post-Traumatic Stress Disorder and Social Phobia. According to the National Institute of Mental Health (NIMH) in the US, 40 million adult Americans suffer from anxiety disorders - 6.8 million of which suffer from GAD andsix million from Panic Disorder.
For GAD sufferers, every day is fraught with worry and potential dangers - Sangeeta fits this criteria. Women are twice as likely to suffer from GAD as men and it can begin at any point in the life cycle, although the years between childhood and middle age are the years of highest risk. There is thought to be a genetic link to GAD. However, environmental factors play a large role, too.
Finnish scientist Iiris Hovatta, who supervised a study looking at the link between genetics and anxiety disorders, says, "Environmental factors, such as stressful life events, may trigger an anxiety disorder more easily in people who have a genetic predisposition to the illness."
NIMH recommends medication and cognitive behavioural therapy as useful tools for helping to ease symptoms of GAD.
Panic Disorder involves repeated panic attacks, which are characterised by an all-consuming fear and a feeling of impending death, teamed with severe physical symptoms, such as chest pains, dizziness, faintness, breathing troubles, cold sweats, shakes and more.
Panic attacks can strike at any time - even when you are asleep - and often seemingly with no cause. Not everyone who has a panic attack will go on to develop Panic Disorder.
About one third of people who suffer from Panic Disorder eventually become housebound, or can only deal with certain situations when they have a trusted person with them. If this happens, the Panic Disorder will have developed into agoraphobia, which is fear of open spaces.
According to NIMH, the tendency to develop Panic Disorder is likely to be inherited and it is one of the most easily treatable forms of anxiety disorder when properly diagnosed.
Stopping the trait
For families with genetic predisposition, anxiety disorders can seem contagious. If every time there is a lightning storm, your mother turns off all the electrics in the house and the fuse box, grabs you and your siblings and hides in a cupboard, chances are you will develop a pretty unhealthy reaction to lightning yourself.
Stockling says, "Unless you are suffering from post-traumatic stress disorder, having high levels of anxiety is likely to be a personality trait - probably picked up from a parent."
For children, having a parent who suffers from an anxiety disorder means they are seven times more likely to develop one themselves, say researchers at the John Hopkins School of Medicine. Their study shows that 65 per cent of children living with a parent with an anxiety disorder already meet the criteria for at least one type of anxiety disorder, even if they haven't been diagnosed yet.
The John Hopkins team worked with 40 children between the ages of seven and 12 who had not been diagnosed with anxiety, but who had at least one anxiety-stricken parent. Half of the families were given eight weeks of cognitive behavioural therapy, the others were not but were offered it a year later. Of the families who were given treatment, anxiety symptoms dropped by 40 per cent and none of the children went on to develop an anxiety disorder within the year of the study.
For the other group, 30 per cent of the children had developed an anxiety disorder by the end of the year.
Suffering from anxiety during childhood puts a child at higher risk of depression, poor academic performance and substance abuse later in life. The cognitive behaviour therapists in the John Hopkins study focused on changing the following behaviours of parents with anxiety disorders in order to prevent the flow of anxiety from parent to child: over-protection, excessive criticism and the excessive expression of fear and anxiety in front of the children.
Treatment methods
Anxiety is an issue people very often live with for years without seeking help until finally they have a panic attack, think they are dying, and book an appointment with a doctor. Alden from the German Centre for Neurology and Psychiatry says, "We don't take our emotions seriously, but we value our physical health greatly. If I am angry, I won't worry. But ifI think my heart will stop, I willpay attention."
NIMH advises medication or psychotherapy to treat anxiety disorders, or a combination of both, depending on the anxiety type and the individuals's specific case and needs. They also say cognitive behavioural therapy is particularly useful for treating anxiety. According to Alden, the best way to ease chronic anxiety and stop the panic attacks would be to remove the source of the stress.
He says, "If you don't like your boss and every time you walk into your office your heart starts palpitating, there is something wrong and there will be mental, emotional and physical ramifications from that. You can try and talk yourself out of it, or you can come and talk to me about it which might help, but it won't go away. If you are suffering from anxiety, it is fixable. But fixing it will come at a cost. Something in your life will have to give."
Are you suffering from anxiety?
Find out if you are suffering from anxiety with psychotherapist Jared Alden's eight telltale symptoms.
1. Sleep shift
"Any type of disturbance in sleeping patterns - too much sleep, too little, difficulties falling asleep, catch-up sleep, sleeping until 2pm on a Friday if you don't normally."
2. Wandering mind
"Forgetfulness that is uncharacteristic - forgetting birthdays or password codes, for example. It is simply a sign that the brain is too occupied with other thoughts."
3. Zoning in
"If someone is preoccupied with something they don't normally pay attention to, we call it hyper-focus. For example, if someone has just spent Dh15,000 on going to the Maldives, but is freaking out about the cost of petrol, I would think there was something else going on."
4. Snap happy
"If someone seems incapable of controlling their mood or their temper, it could be a sign that they are suffering from stress-induced anxiety - for example in a traffic jam, with their children, on the phone to a customer service desk, or in the queue at Starbucks."
5. Verbal signs
"If someone is saying things like, ‘It's not fair' or ‘Yes, but it's the principle' it is a signal that they are under great emotional stress. What they are really saying is, ‘It's really hurt my feelings. I feel like I've taken a lot of hits and I don't think I can absorb another.'"
6. Screen boost
"An increase in spending time on the computer, watching TV or gaming shows that you are using it as an anaesthetic against the pain of something else."
7. Working from bed
"If you wake in the night to check your BlackBerry, you could be putting work at such a high priority that you are putting your emotional and mental health at risk."
8. Emotional withdrawal
"If you are suppressing anxiety, your other emotions will be getting suppressed, too. You can't pick and choose between your emotions - you can't feel and express happy emotions without the negative ones coming out."
Is your partner suffering from anxiety?
Men living in the UAE are at high risk of developing stress-related anxiety, according to Jared Alden. He says that he has many more men coming to him because of anxiety and panic attacks here than he did when working in America or the UK.
He says, "Sometimes I see three men a day suffering from stress-related anxiety, which is unusual. I don't know exactly why this is - it could be that being a guest in another country induces a certain vulnerability... perhaps there is a comfort level that is reduced. This could increase the pressure they feel to succeed in their careers and to provide for and protect their families - if you are in your own country, perhaps you have a stronger support network, or you feel there is more leeway or a back-up plan."
According to Alden, this type of stress-related anxiety is quite easily solved, but solving it does not come for free. He says, "It will mean either working less, earning less, psychotherapy or bearing medication costs... simply acknowledging the situation is not enough. It will need him to respond."
