Anxiety Symptoms, Types, Causes and Treatments

Propranolol For Anxiety: Are Beta Blockers Effective?

Propranolol for anxiety is sometimes prescribed, but is it an effective treatment?

Propranolol — a type of beta blocker — has not been shown to be an effective treatment for anxiety.

The conclusions come from a recent review of the research.

Propranolol works by blocking the action of adrenaline.

The drug is mostly used to treat high blood pressure, but is now sometimes prescribed for anxiety.

Actors, public speakers and musicians in general are known to take them to cope with stage fright.

One study from the 1980s found that 27% of orchestra musicians admitted to taking beta blockers before performances to help their nerves (Fishbein et al., 1987).

Does propranolol for anxiety work?

In general, the evidence for its use in the treatment of anxiety disorders is poor.

The reason being that it only affects the physical symptoms for a short period.

It does not affect the psychological symptoms of anxiety.

In other words: it stops your heart beating fast, but does not reduce the rush of anxious thoughts through your brain.

People who regularly use beta blockers like propranolol for anxiety can find they become reliant on them.

The research on propranolol for anxiety

Propranolol for anxiety is often prescribed ‘off-label’, despite little evidence of its long-term effectiveness.

A recent review of the research concluded that there were few studies of its effectiveness and little evidence it helped in treating anxiety disorders.

The study’s authors concluded that:

“…the quality of evidence for the efficacy of propranolol at present is insufficient to support the routine use of propranolol in the treatment of any of the anxiety disorders.”

Research that has been done has tested propranolol for anxiety against benzodiazepines and placebos.

They found…

“…no statistical difference between the effects of propranolol and benzodiazepines on anxiety and panic attack frequency.
In addition, four […] trials failed to show solid evidence on the therapeutic effect of propranolol in patients with dental phobia, animal-type specific phobia, and social phobia.
No RCTs were available on the effects of propranolol in the treatment of any of other anxiety disorders (e.g. generalised anxiety disorder, obsessive–compulsive disorder (OCD), separation anxiety disorder, or selective mutism.”

The study was published in the Journal of Psychopharmacology (Steenen et al., 2016).

→ Read more about PsyBlog’s anxiety ebook: “The Anxiety Plan: 42 Strategies For Worry, Phobias, OCD and Panic”

What Is Anxiety? Discover The Symptoms, Causes And Best Treatments

It can be hard to tell what is anxiety and whether it needs treatment.

Anxiety is a sense of uneasiness, concern or agitation that varies from mild to severe.

At the milder end, it is vague and starts to make you feel unsettled, jumpy and worried.

Towards the more severe end it provokes inner turmoil, feelings of dread and can have a serious impact on everyday life.

What is anxiety?

Everyone experiences anxiety to some degree and sometimes these responses are severe.

Examinations, medical procedures, public speaking and so on can lead to anxiety and loss of sleep.

How anxiety impacts your everyday life determines whether it is a ‘disorder’ or ‘regular’ anxiety.

Anxiety that causes persistent problems with sleeping or seriously interferes with everyday life could require some treatment.

Some people get very anxious over things which others would not consider that anxiety-provoking.

If you are worrying all the time or regularly experiencing unpleasant physical and psychological symptoms, then this could be a sign of something deeper.

Deep-rooted anxiety often leads to avoidance of the anxiety-provoking object or situation.

This type of anxiety can consistently stop you from doing the things you might otherwise like to do.

Anxiety symptoms

Anxiety typically has both psychological and physical symptoms.

Here are some typical psychological symptoms:

Feeling nervous and tense.
Finding it hard to concentrate and settle down.
Thinking a lot of negative thoughts.
Experiencing a sense of dread that something horrible is about to happen.
Sensation of the the mind being filled with thoughts rushing through it.

Physical symptoms could include:

Problems sleeping.
Feeling sick.
A churning stomach.
Breathing heavily.
Sweating.
Hot flashes.
Muscle tension and headaches.

This is not a completely list, people report many different types of physical and psychological symptoms.

Severe anxiety is also linked to depression, insomnia and misusing drugs.

It can lead to problems at work and in relationships and difficulty in enjoying everyday, pleasurable pursuits.

Causes of anxiety

There are a large range of factors that could influence whether you experience anxiety as a mental health problem.

Here are some possible causes:

Anxious personality. Some people are genetically prone to anxiety.
Childhood experiences. Bullying, hostile parents or other frightening experiences during childhood.
Long-term health problems like chronic pain are linked to anxiety.
Everyday habits such as working long hours, financial or housing problems and stress can cause anxiety.

Often, chronic anxiety stems from a variety of causes specific to your lifestyle, situation and genetics mixed together.

Types of anxiety disorders

Anxiety disorders come in various types.

These are some of the main ones:

Generalised anxiety and worry: constantly worrying about a wide range of issues, rather than something specific.
Social phobia: fear of other people and social interactions. This can stop people with social phobia from getting the things they want: relationships, promotions or just human contact in general.
Specific phobias: fears of things like the environment, snakes, spiders, enclosed spaces, blood, injections and so on.
Panic: involves the experience of intense fear, including a very strong physical reaction and the sensation of being about to die or losing complete mental control.
OCD: people experience intrusive thoughts that are repulsive to them and also possibly engaging in repetitive behaviours.

What is anxiety therapy?

Psychological therapies are very effective for anxiety disorders.

In particular, cognitive-behavioural therapy (CBT) has been found to help many types of anxiety disorders.

Dr Jeremy Dean’s latest book “The Anxiety Plan” is based on the principles of CBT and provides 42 strategies for dealing with anxiety.

Other ways of managing anxiety yourself include:

Support groups.
Eating healthily.
Complementary therapies like yoga and meditation.
Exercise.

Understandably, some people find self-help too difficult.

If so, psychologists, psychiatrists and other mental health professionals can provide the psychological support required.

What is anxiety medication?

Along with psychological therapies, people are often prescribed medications.

Some people find they need medication, but bear in mind that:

It can be difficult to come off medications.
Medications have all sorts of side-effects.
If possible, it is better to learn to deal with anxiety using internal, psychological resources.

Four types of medication are:

Antidepressants. Make you feel calmer, but there are side-effects.
Beta-blockers. Reduce the physical symptoms of anxiety, such as a racing heart and shaking hands. However, they do not change the psychological symptoms.
Tranquillisers. Should only be used in the short-term until you can start therapy or some other treatment.
Pregabalin (Lyrica). This is an anticonvulsant drug sometimes prescribed for anxiety.

Even if you do decide to take medication, also consider self-help options at the same time as these can work better in the long-run.

→ Get Dr Jeremy Dean’s new anxiety ebook.

Psychotherapy Works Best In The Morning

Psychotherapy for those experiencing anxiety works best at particular time of the day.

Psychotherapy works best in the morning, new research finds.

It is partly down to higher cortisol levels in the morning, the study suggests.

People in the study had agoraphobia and panic disorder.

Treatments for anxiety disorders often involve exposure to the phobic situation or object.

With exposure people can learn that their worst fears do not materialise.

Dr Meuret, a clinical psychologist and the study’s first author, said:

“For example, a patient may think that standing in an elevator could cause him or her to lose control or faint, suffocate, or may create physical symptoms that would be intolerable.
By having them stand in an elevator for a prolonged time, the patient learns that their feared outcome does not occur, despite high levels of anxiety.
We call this corrective learning.”

The results showed that people had more success overcoming their fears when tackled in the morning.

Dr Meuret said:

“The hormone cortisol is thought to facilitate fear extinction in certain therapeutic situations.
Drugs to enhance fear extinction are being investigated, but they can be difficult to administer and have yielded mixed results.
The findings of our study promote taking advantage of two simple and naturally occurring agents – our own cortisol and time of day.”

Cortisol levels are likely not the only factor.

Other ways to explain the effect include:

sleep quality and quantity,
natural circadian rhythms,
memory and learning changes,
and attentional control.

Dr Meuret said:

“Notably, higher cortisol was related to greater reductions in threat appraisal, perceived control and panic symptom severity at the next session, and that was the case over-and-above the effects of time-of-day, with large effect sizes.”

The study was published in the journal Psychoneuroendocrinology (Meuret et al., 2016).

Young Women Have Highest Depression And Self-Harm Risk

Only 3% are receiving psychological therapy, the survey of 17,000 found.

Only 3% are receiving psychological therapy, the survey of 17,000 found.

Young women are at the greatest risk of common mental health problems, new research finds.

One in four young women have self-harmed, usually by cutting themselves, according to the UK survey, compared with 10% of young men.

One-fifth of young women had experienced common mental disorders problems.

Women of all ages were much more likely to report severe mental health problems than men.

Around one in eight men reported a common mental health disorder.

A comparison with previous surveys suggests that young women’s mental health is getting worse, while young men’s may be improving.

10% taking medication

Overall, the survey found that one in six adults in England met the criteria for a common mental disorder, like anxiety and depression.

The most common form of treatment people used was medication, taken by 10% of those interviewed.

Just 3% received psychological therapy.

Only one-third of people, though, received any treatment at all for their condition — although treatment levels have increased from one-quarter almost a decade ago.

Stephen Buckley, head of information at the Mind charity, said:

‘Young people are coming of working age in times of economic uncertainty, they’re more likely to experience issues associated with debt, unemployment and poverty, and they are up against increasing social and environmental pressures, all of which affect well-being.’

Mr Buckley blamed the rise on social media:

“Since the last data was released in 2009, we’ve seen a surge in the use of social media.
While social media can promote good mental health and can help people feel less isolated, it also comes with some risks.
Its instantaneous and anonymous nature means it’s easy for people to make hasty and sometimes ill-advised comments that can negatively affect other people’s mental health.
It’s important to avoid sites that are likely to trigger negative feelings and/or behaviour and to take a break from social media if you’re feeling vulnerable.”

The study was carried out by NHS Digital (NHS, 2016).

This Legal Drug Could Protect Brain From Ageing

Could cigarettes contain the latest clue to an anti-ageing drug?

Could cigarettes contain the latest clue to an anti-ageing drug?

Nicotine could help to protect the brain from Alzheimer’s and Parkinson’s disease, new research finds.

The substance — when given independently from tobacco — could help to protect the ageing brain.

The neuroprotective effect of nicotine could be down to its well-known quality of reducing appetite.

For the study, the researchers gave varying levels of nicotine to mice in their drinking water.

There was no evidence, though, that it caused anxiety, which the researchers were concerned would be the case.

Dr Ursula Winzer-Serhan, who led the research, said:

“Some people say that nicotine decreases anxiety, which is why people smoke, but others say it increases anxiety.
The last thing you would want in a drug that is given chronically would be a negative change in behavior.
Luckily, we didn’t find any evidence of anxiety: Only two measures showed any effect even with high levels of nicotine, and if anything, nicotine made animal models less anxious.”

The mice given the highest levels of nicotine ate the least and gained the least weight.

Dr Winzer-Serhan cautioned:

“I want to make it very clear that we’re not encouraging people to smoke.
Even if these weren’t very preliminary results, smoking results in so many health problems that any possible benefit of the nicotine would be more than cancelled out.
However, smoking is only one possible route of administration of the drug, and our work shows that we shouldn’t write-off nicotine completely.”

The next step for the researchers is to test whether nicotine has a an anti-ageing effect.

Dr Winzer-Serhan said:

“Although the results are intriguing, we would need large-scale clinical trials before suggesting anyone change their behavior.
At the end of the day, we haven’t proven that this addictive drug is safe — and it certainly isn’t during childhood or adolescence — or that the benefits outweigh the potential risks.”

The study was published in the Journal of Toxicology (Huang et al., 2016).

The Attitude To Exercise That Benefits Mind And Body To Max

Greatest psychological and neurophysiological benefits seen from exercise with this attitude.

Greatest psychological and neurophysiological benefits seen from exercise with this attitude.

People gain the greatest psychological and neurophysiological benefit when they really believe in exercise, new research finds.

A positive attitude towards sport and exercise is a self-fulling prophecy, explained the study’s first author Mr Hendrik Mothes:

“The results demonstrate that our belief in how much we will benefit from physical activity has a considerable effect on our well-being in the manner of a self-fulfilling prophecy.”

For the study 76 people exercised for 30 minutes on a stationary bicycle.

All saw one of two videos beforehand.

The first praised the positive effects of cycling, the second did not.

The results showed that people who already had positive views of exercise enjoyed the exercise more, had lower anxiety afterwards and better mood.

The video that was positive about cycling had the same effect.

The researchers also made recordings of the electrical activity in the brain

These revealed that those with positive expectations about exercise or who had seen the video were more relaxed on a neuronal level.

Mr Mothes said:

“Beliefs and expectations could possibly have long-term consequences, for instance on our motivation to engage in sports.
They can be a determining factor on whether we can rouse ourselves to go jogging again next time or decide instead to stay at home on the couch.”

Appreciate what you already do

Beliefs are a powerful thing: consider a 2007 study on 84 hotel attendants (Crum et al., 2007).

Some were encouraged to appreciate how much exercise they were already doing as part of their job.

The rest were told nothing.

Incredibly, the average weight of those encouraged to appreciate the exercise they already did reduced from 145.5 lbs to 143.72 lbs.

Over the same period the rest showed no significant change.

That’s like dropping a bag of sugar. In four weeks. With no additional exercise.

Now that’s the power of the mind-body link right there, measured in pounds and ounces.

The new study was published in the Journal of Behavioral Medicine (Mothes et al., 2016).

Image credit: marcovdz

6 Ways Being Connected To Nature Reduces Anxiety

Nature provides people ‘a sense of renewal’ which lowers anxiety, new research finds.

Nature provides people ‘a sense of renewal’ which lowers anxiety, new research finds.

People who feel connected to nature have lower levels of anxiety, recent research finds.

Nature seems to provide people an escape from busy urban environments — a way to let their minds recover.

It may be that it is not even necessary to be in nature to get the benefit, as long as one feels connected to it.

For the research people were asked about what nature meant to them.

Here are six of the themes that emerged when people talked about what nature gave to them:

1. Relaxation

The authors explain:

“…nature induced relaxation and acted as a relief from stress.
Nature was also described as being responsible for feelings of peace and calm.
Some participants indicated that nature provided a sense of renewal, was re-grounding, and created feelings of fulfilment.”

2. Time out

The authors explain:

“…nature providing a sense of being away from the everyday, escape, and refuge.
Participants saw being in nature as being away from the urban environment and providing a sense of freedom.”

3. Enjoyment

People described how being in nature gave them a sense of enjoyment, joy, happiness and contentment.

4. Connection

More than pure enjoyment, though, being in nature gave people the sense of…

“…being connected to something larger and revolved around feeling immersed, being part of something bigger, at one with, or connecting with what was important.
Being connected to nature was occasionally spoken about in terms of being at one with the world which also had secondary benefits of feeling peaceful.”

5. Sensory engagement

A spiritual aspect was also important, the authors write:

“…nature was stimulating to the senses and was associated with ideas of beauty
This often included a spiritual aspect or a sense of the flawlessness of nature.
Nature allowed them to breathe fresh air, experience natural elements, such as sunshine, and find space to be alone.”

6. Healthy perspective

People reported that…

“…nature was responsible for wellbeing and positive health.
Those participants who mentioned the health benefits of nature considered that nature was very important to their everyday lives, their mental health, overall wellbeing, and fitness.”

The study was published in the Journal of Health Psychology (Martyn & Brymer, 2016).

The Seeds of Depression And Anxiety Could Lie In This Room

Creating a perfect storm of negative emotions.

Creating a perfect storm of negative emotions.

Not getting enough sleep as a child increases the risk of developing emotional disorders later on, new research concludes.

Inadequate sleep creates more negative emotions and alters positive emotional experiences.

For example, after just two nights of poor sleep, children cannot get the same pleasure out of positive experiences, researchers found.

The children also found it more difficult to recall these positive experiences later on.

Poor sleep is already known to have all sorts of damaging effects, such as reducing the ability to:

Self-monitor.
Read other people’s body language.
Identify the emotions of other people.
Exercise self-control.

Dr Candice Alfano, who led the study, said:

“Healthy sleep is critical for children’s psychological well-being.
Continually experiencing inadequate sleep can eventually lead to depression, anxiety and other types of emotional problems.
Parents, therefore, need to think about sleep as an essential component of overall health in the same way they do nutrition, dental hygiene and physical activity.
If your child has problems waking up in the morning or is sleepy during the day, then their nighttime sleep is probably inadequate.
This can result for several reasons, such as a bedtime that is too late, non-restful sleep during the night or an inconsistent sleep schedule.”

For the research, 50 children between the ages of 7 and 11 had their sleep restricted for a temporary period.

The researchers concluded that, over time, poor sleep like this is likely to increase the risk of depression and anxiety.

People without the right amount of sleep do not seek out positive and rewarding experiences that require effort.

Dr Alfano said:

“There are multiple emotional processes that seem to be disrupted by poor sleep.
For example, our ability to self-monitor, pick up on others’ nonverbal cues and accurately identify others’ emotions diminishes when sleep is inadequate.
Combine this with less impulse control, a hallmark feature of the teenage years, and sleep deprivation can create a ‘perfect storm’ for experiencing negative emotions and consequences.”

The study was published in the journal Sleep Medicine Reviews (Palmer & Alfano, 2016).

Image credit: Simon Pais-Thomas

Blindfold Test Reveals Whether People Are Anxious Or Uninhibited

People experiencing anxiety walk in this direction.

People experiencing anxiety walk in this direction.

People experiencing anxiety tend to walk to the left, new research finds.

It results from more activity in the right-hand-side of the brain.

The conclusions come from a study in which people were blindfolded and asked to walk in a straight line.

The more inhibited and anxious people tended to veer to the left.

In comparison, people who experience more positive emotions tended to veer off to the right.

The more inhibited and anxious they were, the more people accidentally wandered to the left.

The more positive and approach-oriented, the more they accidentally wandered to the right.

The differences are thought to be due to how approach and avoidance mechanisms are organised in the brain.

Broadly speaking the left-hand-side of the brain is linked to the motivation to approach situations and people.

Since the left-hand-side of the brain is connected to the right-hand-side of the body, people with an approach motivation walk to the right.

The reverse is seen in those with inhibitory or anxious motivational processing.

The study was published in the journal Cognition (Weick et al., 2016).

→ Get Dr Jeremy Dean’s new anxiety ebook, discover the signs of anxiety and learn: what is anxiety?

Blindfolded image from Shutterstock

A Combination Treatment Is Best For Social Anxiety Disorder

Social anxiety disorder is thought to affect around 1 in 8 people, and is more than just being shy.

Social anxiety disorder is thought to affect around 1 in 8 people, and is more than just being shy.

A combination of SSRI antidepressants and cognitive-behavioural therapy is the best treatment for social anxiety disorder, a new study concludes.

Brain scans showed that the combined therapy reduced the neural response in the amygdala — part of the brain central to processing fear and anxiety.

Social anxiety disorder is thought to affect around 1 in 8 people, and is more than just being shy.

The condition often strikes at important moments in people’s life and usually leads to a significant reduction in their quality of life.

The study compared people with social anxiety who received therapy plus antidepressants with those receiving therapy plus a placebo.

Nine weeks after treatment, those who had taken the antidepressant combined with the therapy were doing better.

They were even more improved compared with the other group 15 months later.

Dr Malin Gingnell, one of the study’s authors, said:

“We have now preliminary support to say that the SSRI escitalopram adds to the effect of CBT for social anxiety disorder and that clinical response is linked to reduced activation of the amygdala.”

Set against this study, a recent review of the research I reported found that:

“Social anxiety disorder is most commonly treated with antidepressants, but these are not the most effective treatment.
…cognitive behavioural therapy (CBT) is more effective and the benefits continue after the initial treatment has finished.
[…]
The researchers found that it was the psychological therapies that were the most effective.
As a result these should be the first choice treatment.
Antidepressants were also effective, but were associated with side-effects, and they don’t work for some people.
More importantly, the beneficial effects of medication tend to wear off after discontinuation.”

→ Get Dr Jeremy Dean’s new anxiety ebook.

The study was published in the British Journal of Psychiatry (Gingnell et al., 2016).

Anxious woman image from Shutterstock