…..Continued from the last edition
By Dr. Colin Michie of AUC Medical School
Dr. Colin Michie has worked as a paediatrician in the United Kingdom, Africa, the Caribbean and the Middle East. He is specialised in nutrition, haematology and infectious diseases. Now the Associate Academic Dean for the American University of the Caribbean Medical School in Sint Maarten, his enthusiasm is training medical students and healthcare teams to ensure they deliver better value health care.
These numbers are huge, but they are supported by history. Early on in the Second World War, British military doctors described high levels of stomach ulcers among the soldiers and in particular among the evacuees from Dunkirk. “War ulcers” resembled the “air-raid ulcers” found in the civilian populations in large cities during periods of bombing. Importantly, they also showed trajectory: Some individuals who developed anxiety disorders as children went on to develop other types of anxiety disorders as they became older, with about a third having problems that extended into their adult lives.
Psychiatrists classify anxiety disorders into a number of distinct categories. This approach helps determine treatment and sometimes indicates how long a problem will last. The most common anxiety problem is called generalized anxiety disorder. There are also phobic disorders, in which someone has become specifically frightened of one situation, such as social situations or open spaces (agoraphobia). Panic disorders are different and they require different types of care. Less common anxiety problems most often seen particularly in children include separation anxiety and selective mutism.
Geneticists believe some family genes make anxiety disorders more common; in particular, panic attacks and some phobias. However, life events, particularly being subjected to violence, chronic illness, problems in early childhood, and separation from or the death of loved ones can all have powerful effects on individuals, causing anxiety, irrespective of an individual’s genetic makeup.
There are many ways we can help ourselves if we become anxious or stressed. One of the first is to recognize how anxiety affects our lives. For example, many who are anxious start to snack; the term “comfort food” has sound foundations. Avoid sugary snacks such as candy, cake, ice-cream and cookies. Although these will give you a serotonin “high”, they are likely to increase further cravings for sweetness.
Several strategies will help you reduce anxiety. These include regular physical activity or exercise. This is known to reduce sympathetic activity and so is likely to be of benefit for most anxiety disorders. Mindfulness based techniques or meditation have also been shown to be effective in treating anxiety. Talking to others, sharing your concerns, as well as prioritizing your lists and jobs will help give you new perspectives and help manage your time more effectively.
Good sleep too is particularly important: An excellent set of tips was given on this in The Daily Herald on December 7, 2017 (https://www.thedailyherald.sx/supplements/health-beauty/71653-11-tips-to-beat-anxiety-and-get-some-sleep).
Although no herbal remedy has been found as efficacious as mainstream strategies, several herbal preparations may assist you. Some excellent resources are available if you feel stressed and anxious. These include the website for the Anxiety and Depression Association of America (https://adaa.org/tips-manage-anxiety-and-stress) which links many agencies and their materials, or the Anxiety and Stress Management Institute (https://www.stressmgt.net).
The essence of psychological treatments for anxiety includes counselling, education about anxiety disorders and a guide to self-help resources. Psychotherapy is the most valuable first line treatment for anxiety disorders, particularly individualized cognitive behavioural therapy delivered by a trained therapist. This methodology is evolving steadily; for instance, a metacognitive approach has been found even more effective than routine cognitive behavioural therapy in some centres. New non-invasive therapies, such as transcranial magnetic stimulation, may become useful and some services are developing virtual reality techniques to augment their cognitive therapies.
In a crude assessment, daytime brain activity represents a balance between positive and negative influences. Positive drives are largely delivered by serotonin; negative ones by gamma-aminobutyric acid (GABA). In anxiety disorders, it is thought that increasing serotonin can be valuable and there may be a role in some disorders for the use of selective serotonin reuptake inhibitors (SSRIs), serotonin norepinephrine reuptake inhibitors (SNRIs) and calcium channel modulators. Benzodiazepines (drugs like Valium) were once a favoured treatment for anxiety, particularly for panic attacks, because they act on GABA receptors and increase negative or calming effects on the brain and other parts of the nervous system. However, these drugs are habit-forming and can have serious side effects.
With such a common set of disorders affecting so many in our community, it is important to plan and develop prevention. Working with children will reduce the rates of anxiety disorders in later life. Providing positive environmental factors to children, teaching them effective coping strategies, supporting bonding within families, promoting new learning experiences, and helping children develop strong social support networks will increase their ability to cope with problems like stress. Regular physical activity too, particularly if started in childhood, will have positive effects on mood and psychological protection. As Shakespeare wrote in Hamlet:
“Whether 'tis nobler in the mind to suffer
The slings and arrows of outrageous fortune
Or to take arms against a sea of troubles
And by opposing, end them?”
In the case of anxiety disorders, it is important to “take arms...” as these problems can be treated with a good prognosis: they do not have to interfere with the day-to-day quality of our lives. Many aspects of our St Maarten communities are positive and healthy; our local environment can help prevent the development of anxiety disorders. Support by teachers, congregations or foundations is effective in providing proactive care for children and reducing social isolation of the vulnerable.
Members of our medical school routinely comment about the friendliness and support they receive on this island. The many thousands of tourists visiting St. Maarten echo these sentiments. As Laurelle Richards wrote, “St. Martin culture opens us to the world and opens the world in us.” Her advice is valuable if anxiety and its impacts are to be prevented.
Dr. Michie expresses thanks to Dr. Danny Wedding, Consultant Clinical Psychologist and Senior Faculty at the AUC, for his editing of this document.
