Understanding Anxiety
Worry and fear are a normal human response to the everyday stressors and unsettling situations we all experience in life. It is when the fear response to a perceived danger or stressful event becomes all consuming and is clearly out of proportion to the actual event that an anxiety disorder may be at work. When excessive worrying interferes with normal daily activities it can manifest itself in one or more types of anxiety disorder.
Symptoms of Anxiety Disorders
Each of the several anxiety disorders within the anxiety spectrum has unique symptoms, diagnostic criteria, and treatment protocol. According to the Anxiety and Depression Association of America, 40 million Americans struggle with an anxiety disorder each year. The most common are generalized anxiety disorder (GAD) with 6.8 million adults affected, and post-traumatic stress disorder (PTSD), with 7.7 million adults affected. The Diagnostic and Statistical Manual of Mental Disorders, fifth edition (DSM-5) categorizes anxiety disorders into three categories:
Anxiety disorders
- Generalized anxiety disorder
- Social anxiety
- Phobia
- Panic disorder
- Separation anxiety disorder
- Substance-medication induced anxiety disorder
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Diagnostic Criteria for Anxiety Disorders
The diagnostic criteria for all anxiety disorders are available in the DSM-5. Here are the criteria for GAD, provided by the American Academy of Family Physicians:
Generalized Anxiety Disorder: Excessive and uncontrollable worry over events and perceived negative outcomes. DSM-5 diagnostic criteria:
- Excessive anxiety and worry (apprehensive expectation), occurring more days than not for at least 6 months, about a number of events or activities (such as work or school performance).
- The individual finds it difficult to control the worry.
- The anxiety and worry are associated with three* (or more) of the following six symptoms, with at least some symptoms having been present for the majority of days for the past six months:
*only one required in children
- Restlessness or feeling keyed up or on edge
- Easily fatigued
- Concentration problems
- Irritability
- Muscle tension
- Sleep disturbance
- The anxiety, worry, or physical symptoms cause clinically significant distress or impairment in social, occupational, or other important areas of functioning.
- The disturbance is not attributable to the physiological effects of a substance (i.e., drug of abuse or a medication) or another medical condition.
- The disturbance is not better explained by another mental disorder.
How TMS Treats Anxiety Disorders
According to an article in the Psychiatric Times, between 30-50% of patients do not respond to the standard treatments for anxiety, indicating a need for alternative or complimentary therapies in seeking relief from anxiety symptoms. For treatment-resistant anxiety, transcranial magnetic stimulation (TMS) is providing hope to those whose lives are negatively impacted by an anxiety disorder.
TMS is a neurostimulation therapy that uses magnetic fields applied through a coil placed over the scalp. By targeting the specific brain regions that regulate threat appraisal, conflict monitoring, risk aversion, and emotion regulation, TMS is providing promising results in tackling anxiety disorders. Clinical findings indicate that by targeting the left dorsolateral prefrontal cortex (DLPFC), TMS therapy can alter cortisol secretions and modify emotion regulation of anxiety, leading to sustained symptom relief and improved quality of life. TMS is safe, noninvasive, requires no sedation, and is very well tolerated by patients.
