What are the Symptoms?

Anxiety comes in many forms and the symptoms can vary greatly from person to person.
A person may experience:

• Fearful anticipation and muscle tension
• Irritability and sleep distu­rbances
• Noise sensitiveness and restlessness
• Worrying thoughts and difficulty co­n­ce­ntrating.

The fear may be accompanied by tightness of the chest, palpitations, tingling and ‘butterflies’ in the stomach.
As symptoms intensify they can include feelings of breathlessness, dizziness, sweating and trembling, racing heart, dry mouth, chills or hot flushes, choking, nausea, stomach upset, and pins and needles in the hands.
Some people feel like they are going to lose control or die and may feel as if they are having a heart attack, among other medical disorders.
There may also be general symptoms of tiredness, headaches, loss of appetite, constipation or even diahorrea.
The person will avoid the situation that is predisposing to the stress. An extreme case is where the person is terrified of all forms of social contact, even to the point of being unable to leave home. The person is aware of the irrational and excessive nature of his or her fears. When he or she comes for treatment, he or she says, “I know my fears are unreasonable, but I just can’t seem to stop them.”
As described in the opening paragraph to the article, upon Arjun asking Bhagwan Krishna to drive his chariot into the midst of the two armies, he is faced with the brutal reality of having to go into battle with his kinsman, elders and guru. The enormity of the sinful task that he has to undertake overwhelms him. Thus, Arjun experiences the physical symptoms, mental anguish and emotional turmoil in keeping with a person unable to function due to the severity of his anxiety.
In reply, Bhagwan Krishna explains to Arjun the futility of his anxiety and the epic poem, the Bhagavad Gita, is revealed to us all. Krishna tells him it is not sinful for him to do his duty as a Kshatriya – it is a war between dharma and adharma. The Bhagavad Gita contains probably the first literary description of the symptoms of anxiety and more significantly, Bhagwan Krishna’s oration on the Kurukshetra battlefield, describes its holistic treatment.

Treatment

In every case, there is a need for careful medical assessment, as it is important to exclude an underlying medical cause to the anxiety. Once an anxiety disorder is diagnosed, medication together with psychological treatments may be prescribed. Psychological treatment such as relaxation training, meditation, biofeedback and stress management can help. One of the most effective forms of treatment is Cognitive Behavioural Therapy (CBT).

Cognitive Behavioural Therapy

Specific Drug Therapy

People suffering from panic attacks as part of an anxiety disorder may be helped with tranquillizers, anti-depressants and other classes of drugs.
Tranquilizers are usually only prescribed in specific cases, to control such unpleasant side effects of anxiety as panic attacks or high levels of anxiety or arousal.

Education and Psychological Therapy

There are a range of psychological therapies for anxiety, aimed at helping the person control their arousal levels and manage their panic attacks.
Education, therapy and counselling can help them understand their thoughts, emotions and behaviour and give them new ways to deal with their anxiety.
Counselling can also assist the person to stop drug or alcohol use, resolve life stresses, and develop overall better coping skills. Education and counselling help the person reduce stress, resolve conflicts, manage their life more effectively, develop new ways of thinking about themselves and the world, and develop new ways of enjoying activities.
Part of the treatment may involve helping the person avoid family conflicts and developing ways of using their family as a means of support and encouragement.
Cognitive behavioural therapy (CBT) is established as the first-choice psychological treatment for anxiety disorders. CBT helps patients identify, question and correct their tendencies to overestimate danger and their perceived inability to cope with danger. Patients recognize that their thoughts, attitudes and beliefs can generate and maintain anxious states. Common distortions in thinking are identified and restructured. This leads to modifications in behaviour, thus alleviating anxiety.
Bhagwan Swaminarayan through the Vacha­namrut sets forth a philosophy that shifts the reader’s thinking, attitudes and belief systems. Distorted perceptions are set straight, thus a cognitive shift is achieved in the study of the Vachanamrut. This is further reinforced by Gunatitanand Swami’s Swamini Vato which reveals further eternal truths. Both treatises, although written over 200 years ago, are only now being understood by Western thinking.
What is interesting in the BAPS Sanstha is that through Pramukh Swami Maharaj we see a living embodiment of anxiety-free behaviour. These are captured in his responses to the challenging experiences he has had:

• Being turned back at Nairobi airport (1974)
• Being falsely set up to be arrested (1977)
• Upon experiencing a heart attack (1983)
• Awaiting a cardiac procedure (1998)
• Gandhinagar Akshardham attack (2002).

Pramukh Swami Maharaj demonstrates the optimal cognitive mindset of a person who in spite of facing high anxiety situations and circumstances maintains a calm, collected and balanced state. This is further reflected in his exemplary behaviour amidst the many worldly stressors that Swami is surrounded by. Swami additionally teaches how to proactively deal with stress through his words and deeds. He has advised those individuals who have asked, in thousands of letters, how to deal with specific stressors and problems they were facing.

Other simple techniques to cope with anxiety:

• Meditation, mindfulness, muscle relaxation, yoga and spiritual reading of God or guru’s divine stories
• Exercise daily – this releases ‘feel good’ and naturally uplifting hormones called endorphins
• Talk about your worries with someone you trust
• Find balance between work, hobbies, family and social life, and try to remove factors that cause stress
• Learn deep-breathing techniques to help deal with a panic attack
• Eat a vegetarian diet
• No alcohol, cigarettes and drugs
• Reduce tea and coffee intake and stop if possible
• Develop a good sleep pattern
• Build your self-esteem and keep a positive outlook on life.

Case Studies

Mr. S has had recurrent, unexpected panic attacks for the past three years: “They started one Monday morning when I was caught in the traffic on my way to work. I began to shake, feel dizzy, and could not concentrate on the road. I became short of breath and had to open the car windows. My chest was pounding and I felt that I was going to pass out. I thought I was having a heart attack. I thought I was going to faint or worse, die! I started to sweat and shake all over. I managed to stop on the side and called my son. He insisted that we go to a hospital, but I refused as I felt fine. However, I began to experience these attacks in shopping malls, and even on the train. I spent most of my day worrying and waiting for the next attack. I avoided going out as I would not be sure if I would have an attack. I eventually agreed to see a doctor, who ruled out any medical cause to the symptoms. That was a great relief as I really felt that there was something wrong with my heart. He referred me to a psychiatrist who initiated medication and also referred me for psychotherapy. I have since improved and these attacks are very infrequent, if any.”

Mr. J, a businessman, who commuted to his workplace in South Mumbai daily by train for years, came to the clinic accompanied by his wife. He reported that the company he had worked for diligently for the last 22 years had retrenched numerous staff early this year. Although he had not been retrenched, there was nervous anticipation that there were going to be future retrenchments and this had created more uncertainty in his workplace.
For the last three months he noticed a tightness in his chest and felt like he was being smothered by a pillow while he was travelling on the overcrowded peak morning Western Line to work. These attacks had gradually got worse and he had had to get off the train on many occassions prior to reaching his final destination at Churchgate Station. He had begun to take the very early train to work or the very late train from work to avoid the crowds and also would stand near the exit of the train so that he could escape from the crowds if he felt the need.
However, his anxiety became worse and he had begun to feel anxious even when he ventured out into the overcrowded Mumbai streets and bazaars making him eventually housebound. Family functions like weddings, where there were large crowds, also became challenging. He constantly needed a family member or friend to accompany him outside.
Mr. J was initiated on medication and psychotherapy. He also learnt breathing techniques and started the practice of meditation and yoga to assist in relaxing. He showed gradual improvement and is now able to leave his home alone and journey to work relatively incident free.