Angst Anhang 2
[Dr. Manisha Bhatia]
Homeopathy treatment for anxiety disorders and panic attacks. Cause and
mechanism of anxiety with homeopathic medicines for anxiety.
The article describes use of homeopathy for anxiety. It covers the basic
information about anxiety disorders, their cause, general management and best
homeopathic
remedies for its homeopathy treatment..
What is anxiety?
Anxiety is a normal response to stressful events or we can say that it
is an alarm mechanism to prepare an individual for a physical response to
perceived danger.
However, when it happens out of place or is out of proportion, it
becomes the anxiety disorder.
You can better understand the nature of anxiety by looking at both what
it is and what it is not. For example, anxiety can be distinguished from fear
in several ways.
When you are afraid, your fear is usually directed toward some concrete
external object or situation. The event that you fear usually is within the
bounds of possibility.
You might fear not meeting a deadline, failing an exam, being unable to
pay your bills, or being rejected by someone you want to please. When you
experience anxiety,
on the other hand, you often can specify what it is you’re anxious
about. The focus of anxiety is more internal than external; it seems to be a
response to a vague, distant,
or even unrecognized danger. You might be anxious about “losing control”
of yourself or some situation. Or you might feel a vague anxiety about “some
thing bad
happening”.
Anxiety affects your whole being. It is physiological, behavioral, and psychological reaction all at once. On a
physiological level, anxiety may include bodily reactions
such as rapid heartbeat, muscle tension, queasiness, dry mouth, or
sweating. On a behavioral level, it can sabotage your
ability to act, express yourself, or deal with
certain everyday situation.
Psychologically, anxiety is a subjective stage of apprehension and
uneasiness. In its most extreme form, it can cause you to feel detached from
yourself and even fearful
of dying or going crazy.
The fact that it can affect you on a physiological, behavioral,
and psychological level has important implications for your attempts to
recover. A complete program of
recovery from an anxiety disorder must intervene at all three levels to
Reduced physiological activity
Eliminate avoidance behavior
Change subjective
interpretations which perpetuate a state of apprehension and worry
Anxiety can appear in different forms and at different levels of
insanity. It can range in severity from a mere twinge of uneasiness to a
full-blown panic attack marked
by heart palpitations, disorientation, and terror. Anxiety that is not
connected with any particular situation, that comes “out of the blue,” is
called free floating anxiety
or in more severe instances, a spontaneous panic attack. The difference
between an episode of free floating anxiety and spontaneous panic attack can be
defined by
whether you experience four or more of the following symptoms at the
same time (the occurrence of four or more symptoms defines a panic attack):
Shortness of breath
Heart palpitations
Trembling or shaking
Sweating
Choking
Nausea and abdominal distress
Numbness
Dizziness and unsteadiness
Feeling of detachment or being
out of touch with yourself
Hot flushes or chills
Fear of dying
Fear of going crazy or out of
control
If your anxiety arises only in response to a specific situation, it is
called situational anxiety or public anxiety. If you have a disproportionate
apprehension about driving
on freeways, going to the doctor, or confronting your spouse, this may
qualify as situational anxiety.
Situational anxiety becomes phobic when you actually start to
avoid the situation. If you give up driving on freeways, going to
doctors, or confronting your spouse altogether.
Often anxiety can be brought on merely by thinking about a particular
situation. When you feel distressed about what might happen when or if you have
to face one of
your phobic situations, you are experiencing what is called anticipatory
anxiety.
Cause of Anxiety
Anxiety may be caused by a psychological condition like prolonged or
unusual stress, a physical disease like hypoglycemia,
hyperthyroidism, caffenism; the effects of drugs,
addictions, or a combination of these. Anxiety symptoms are considered
clinically important when they are abnormally severe, usually prolonged and
when cause impairment
in social or occupational functioning.
Mechanism of Anxiety
anxiety cause and symptoms
Five neurotransmitters [serotonin, norepinephrine, gamma-aminobutyric acid (GABA), corticotropin-releasing hormone (CRH), cholecystokinin]
are involved in managing the state of anxiety. Serotonin and GABA are
inhibitory as they quiet the stress response, while the other neurotransmitters
play a part in triggering it.
The amygdala and the hippocampus are two parts
of the brain that play the most important role in anxiety. If there is a
threat, amygdala will alert the rest of the brain,
including the hippocampus, which creates memories from the threatening event
that are then stored back in the amygdala. The amygdala and hippocampus are both responsible for
activating the hypothalamic-pituitary-adrenocortical
(HPA) axis, the system that regulates the stress response.
Symptoms are initiated by a part of the brain-stem called the locus ceruleus. When there is a stressful situation, neurons in
the locus ceruleus start firing more intensely than
usual. Norepinephrine is then released from the nerve
endings to act on the heart, blood vessels and respiratory centers,
causing the rapid heartbeat, higher blood pressure and quick breathing. The hypothalamus
stimulates the sympathetic nervous system to release the stress hormone
corticotrophin-releasing hormone, or CRH. CRH then acts on the adrenal cortex
to release glucocorticoids. This is the biochemical
mechanism for anxiety. The memories of the past stressful events stored in amygdala, can precipitate or simulate the whole experience
of the event and result in a anxious state or even a panic attack.
Anxiety Symptoms mainly include:
Nervousness
Fear and apprehension
Irritability
Nausea
Instability
Increased startle response
Insomnia or disturbed sleep
Mental and physical
restlessness
Lack of concentration or
abstraction of mind
Over sensitiveness
Increased sweating
Palpitation
Loss of appetite
Diarrhea
Faintness
Dyspnoea
Loss of libido
Difficulty in swallowing
Numbness and tingling
Dizziness
Anxiety Treatment
Conventional treatment of anxiety disorders usually consists of a
combination of psychotherapy, behavioral therapy, and
medication. Psychological counseling can include
cognitive-behavioral therapy (CBT), psychotherapy, or
a combination of therapies. Medicines which are commonly used to control some
of the physical and mental symptoms include antidepressants, SSRI’s, benzodiazepines, tricyclics,
and beta-blockers etc.
Homeopathy Treatment for Anxiety
The selection of remedy is based upon the theory of individualization
and symptoms similarity by using holistic approach. This is the only way
through which a state of complete health can be regained by removing all the
sign and symptoms from which the patient is suffering. The aim of homeopathy is
not only to treat anxiety but to address its underlying cause and individual
susceptibility. As far as therapeutic medication is concerned, several
well-proved homeopathy medicines are available for treatment of anxiety
disorders that can be selected on the basis of cause, condition, sensation and
modalities of the complaints. For individualized remedy selection and
treatment, the patient should consult a qualified homeopathic doctor in person.
Some important remedies are given below for homeopathy treatment of anxiety:
Puls. Sep. Nat-m. Lach. Acon. Ars. Op. Calc. Stram. Cupr-met. Hyos. Gels. Arg-n. Lyss. Cann-i. Lyc.
Kali-c. Camph. Med. etc.
Acon.: Complaints so sudden and violent that the
patient is under great nervous irritation, and excitement. Even trivial
complaints + great fear and anxiety of mind.
Great anxiety and excitement, hasty in every action. Tendency to start
at everything; thinks his thoughts are coming from stomach; music is unbearable
and makes her sad, complaints from fright, anxiety and excitement. Extremely
restless, mentally as well as physically. Patient tosses about in agony, must
change his position often. Fear of future, fear of going out, of crowd, of
crossing street.
Ars.: anxiousness and mental restlessness. Always
moving from one place to another, physically too weak to move, so he wants to
be moved from place to place, Fear of death; fear that he is having some
incurable disease. Sad and hopeless of recovery; Fear when alone, anxiety about
money, feels as if he will die soon. Suicidal tendencies, weary of life.
Impulse to commit suicide, over sensitiveness to circumstances and
surroundings, patients is extremely fastidious, wants everything in proper
place, even when he or she is sick.
Sulph.: anxiety with fainting spells, profuse sweating,
worse in the morning. Mentally lazy, always tired, occasionally restlessness
and hasty. Irritable, impatient of others, selfish, easily excited and
offended. Always in dreams, delusions, thinks rags to be beautiful things. He
is a ragged philosopher, very unclean, does not care for neatness,
he thinks there is no need of cleanliness. Suspicious and mentally
depressed. Very forgetful, confused, absent minded, having aversion to mental,
as well as physical efforts. Aversion to bathing. Overambitious, day-dreams, boaster.
Arg-n.: anxiety makes the patient to walk fast; due to
anticipation, patient is very anxious and nervous, apprehension and fear, when
getting ready to go to any gathering
such as church or opera etc, diarrhea sets in.
Always in hurry, time passes too slowly.
Impulsive, impulse to jump, when in a high place.
Fear of crossing corners of street, fear of death, fear of looking at
high places. Patient is sad, melancholic with great anxiety, forgetfulness and
dullness. Defective memory, Child does everything in great haste. Cannot face
the strangers.
Borx.: Anxiety aggravated by
upward or downward motion, going in elevator, worse till 11 p.m. Great fear of
downward motion, child cries when laid down in the bed,
he clings to the nurse. Fear of falling when rocking, dancing, singing,
going downstairs, or going rapidly down to the hill. Fidgetiness and
nervousness.
Anxious about trifles, anxious during downward motion, excessive
nervous, easily frightened by slightest noise or an unusual sharp sound, a
cough, a sneeze, cry, lighting
a match etc. Patient becomes nauseated and excitable after mental
exertion and in anxiety. Children wake suddenly, screaming and grasping sides
of cradle without apparent cause.
Bry.: anxious about business, even when seriously ill;
mind is hazy and confused. The patient dozes frequently, while his eyes are
closed, he sees people who are not in the room. Mild type of delirium first
during sleep, and later on during waking hours.
Talks incoherently, about his business affairs or events of recent
happening, wants to go home as he thinks he is away from home; he wants
something but do not know what he wants, desires things which cannot be had,
which are refused when offered.
Caus.: full of
apprehension; patient is melancholic, lachrymose, hopeless, and foreboding.
Prone to fits of anger, startled easily, the least things make the child cry
who is peevish. Forgetful, taciturn, and extremely restless, especially at
night.
Always anticipating some dreadful events, patient lacks mental balance,
hysterical women who have lost all control of herself, especially at night. Intensely
sympathetic for suffering of others, ailments are worse when thinking about
them. Mental symptoms that come on from suppression from skin eruptions.
Calc.: anxiety and fears in the evening with restlessness and palpitation,
mental weakness, inability to prolonged mental exertion, difficult thinking.
Weak memory, confusion, misplacing of words, forgetfulness, indolence.
Irritable, obstinate, and sad. Inclined to weep, fear of insanity and
anxious. Ailments from prolonged worry or anxiety, prolonged application to
business, from excitement of the emotions. Fears loss of reason, fear of death,
of consumption, of misfortune, of being alone. Horrible dreams, startled at
every noise.
Gels.: Anxiety due to fright, fear, exciting news, stage fright; worse
while appearing for examination or interview etc.
Ign:. Anxiety due to grief or mental shock, alteration
of opposite mental states, such as joy and sorrow, or laughing and weeping.
Patient weeps and broods in solitude, becomes hysterical from disappointment;
patient weeps, laughs, shrieks, jerks and twitches and may go in to convulsions
or faint. Involuntary sighing.
Unable to control her emotions and excitement. Absent-minded, aversion
to company
Anac.: Dullness and sluggishness of mind, memory
impaired or sudden loss of memory, anxiety better after eating. Absent mindedness,
lack of confidence in himself and others, very easily offended. Irresistible
desire to curse and swear, tendency to use violent language, aversion to work,
indolence, all complaints are worse from mental exertion. Thinks he is
possessed of two wills, one commanding to do what other forbids; hallucinations
that a demon sits on one shoulder and an angel on the other, feels he is
double, mind and body are separated. Suspicious about everything around him,
anxious while walking, as if someone is pursuing him.
Note: The above homeopathy medicines are just an indicator of how we can
treat anxiety disorders with homeopathy. Please consult a qualified homeopath
in person for a full case analysis and to find the best homeopathy remedy for
your individual case.
Phytologie:
Lampenfieber Massageöl
5 Tropfen Melisse
4 Tropfen Römische Kamille
4 Tropfen Fenchel
3 Tropfen Zimtrinde
3 Tropfen Grapefruit
1 Tropfen Lavendel
3 Esslöffel Kokosöl
Den Nacken und die Schultern damit einmassieren, 2x im Abstand von 6
Stunden. Hilft Angst zu überwinden.
[Jabulile Cesancia Ngobese]
http://ir.dut.ac.za/bitstream/handle/10321/26/Ngobese_2006.pdf?sequence=15&isAllowed=y
The Relative Efficacy of Homoeopathic Simillimum
Treatment as Compared to Psychological Counseling
(Cognitive Therapy and Behavioral Therapy) in the
Management of Generalized Anxiety Disorder.
Generalized Anxiety Disorder (= GAD), is defined in the Diagnostic and
Statistical Manual of Mental Disorders (DSM-IV) as excessive and pervasive
worry, accompanied
by a variety of somatic symptoms, that causes significant impairment in
social or occupational functioning or marked distress in the patient (Kaplan
and Sadock, 1996: 214).
In a current report a survey found that anxiety disorders represents the
largest mental health problem in the general population, with an incidence of
anxiety disorders being 12,6% of the general population or greater.
Consequently it may be assumed that millions of South Africans experience an
anxiety disorder. This disorder is unlikely to remit without treatment.
Symptoms may begin early or late in life, but findings suggest that they
usually persist after onset. Given the chronicity of
the disorder, development of new, more effective treatment is crucial
(Kimberly, 2003).
According to Kessler and Wittchen (2002:6),
GAD is more commonly found among women than men and among people of various
disadvantaged social statuses (e.g. low income and education, racial or ethnic
minorities) compared with their more socially advantaged counterparts with the
highest current prevalence of GAD found among people in the middle years of
life. Despite the prevalence of GAD, little is known of its natural course, as
Keller (2002: 11) states that the duration of illness exceeds that required for
its diagnosis (presence of symptoms for at least 6 months), and at present GAD
is poorly recognized and is consequently often under treated.
Patients with GAD are more likely to present in a primary health care setting
than to a psychiatrist. They are likely to complain of somatic symptoms, and
may be referred for unnecessary medical investigations.
Patients with GAD may present co-morbid mood, anxiety, or substance-use
disorders. Untreated, GAD is a chronic condition. The course is likely to
depend on co-morbid disorders. Negative life events are likely to exacerbate
symptoms. Treatment may significantly benefit patients (Robertson, Allwood and Gagiano, 2001:
148).
Barlow and Durand (1995: 164) state that many primary care physicians
treat Generalized Anxiety Disorder exclusively by prescribing anti-anxiety
medication.
However, these drugs are not without risks. They cause impairment of
cognitive functioning such as reaction time and many individuals experience
rebound anxiety if they abruptly stop taking the medications (Barlow and Durand
1995: 164).
Problem Statement
The aim of this double-blind placebo-controlled study was to evaluate
the relative efficacy of homoeopathic simillimum
treatment as compared to psychological counselling (Cognitive Therapy and
Behavioural Therapy) in the management of Generalized Anxiety Disorder, by
means of the Hamilton Anxiety Rating Scale (Appendix F), the Beck Anxiety
Inventory (Appendix G) and the Patient
Perception Questionnaire
1st objective was to determine the effectiveness of
homoeopathic simillimum treatment, psychological
counselling (Cognitive Therapy and Behavioural Therapy) and placebo
in the management of GAD signs and symptoms in terms of the Hamilton
Anxiety Rating Scale (refer Appendix F).
2nd objective was to determine the effectiveness of
homoeopathic simillimum treatment, psychological
counselling (Cognitive Therapy and Behavioural Therapy) and placebo
in the management of GAD signs and symptoms in terms of the Beck Anxiety
Rating Scale (refer Appendix G).
3rd objective was to determine the effectiveness homoeopathic
simillimum treatment, psychological counselling
(Cognitive Therapy and Behavioural Therapy) and placebo in the management of
GAD signs and symptoms in terms of the Patient Perception Questionnaire (refer
Appendix H).
4th objective was to compare the effectiveness of the three
groups (Simillimum group, Psychological Counselling
group and Placebo group) with each other with regard to
the three measurement tools.
DD.: The differential diagnosis of GAD includes all the medical
disorders that may cause anxiety, such as hyperthyroidism, caffeinism
and cardiac arrhythmias.
It is necessary to rule out the presence of co-morbid psychiatric,
medical disorders, mood disorders such as depression and dysthymia,
and other anxiety disorders.
In addition, attention should be paid to the possibility of co-morbid somatization disorder or substance abuse, dependence, or
withdrawal. In particular, excessive alcohol
and caffeine use may contribute to chronic anxiety symptoms and should
be excluded (Stein, Seedat, Niehaus,
Pienaar and Emsley: 2000:
109).
The co-morbid disorders are:
Anxiety disorder due to a general medical condition
A Substance-Induced anxiety disorder
Panic Disorder
Social Phobia
Obsessive-Compulsive Disorder
Anorexia Nervosa
Hypochondriasis
Somatization Disorder
Separation Anxiety Disorder
Post-traumatic Stress Disorder
Adjustment Disorder
(DSM-IV, 1994:434-435).
The Model of Layers:
As mankind becomes afflicted by more and more morbific
influence, these tend to build layers of disease susceptibility. Miasms build one upon another representing a deepening of
ill health. The vital force now seeks more complex means to defend against the
complexities of our present condition of ill health (Roberts, 1993:74).
Generalized Anxiety Disorder (GAD), is defined in the Diagnostic and
Statistical Manual of Mental Disorders (DSM-IV) as excessive and pervasive
worry, accompanied
by a variety of somatic symptoms, that causes significant impairment in
social or occupational functioning or marked distress in the patient (Kaplan
and Sadock, 1996:214).
In a current report a survey found that anxiety disorders represents the
largest mental health problem in the general population, with an incidence of
anxiety disorders being 12,6% of the general population or greater.
Consequently it may be assumed that millions of South Africans experience an
anxiety disorder. This disorder is unlikely to remit without treatment.
Symptoms may begin early or late in life, but findings suggest that they
usually persist after onset. Given the chronicity of
the disorder, development of new, more effective treatment is crucial
(Kimberly, 2003).
According to Kessler and Wittchen (2002:6),
GAD is more commonly found among women than men and among people of various
disadvantaged social statuses (e.g. low income and education, racial or ethnic
minorities) compared with their more socially advantaged counterparts with the
highest current prevalence of GAD found among people in the middle years of
life.
Despite the prevalence of GAD, little is known of its natural course, as
Keller (2002:11) states that the duration of illness exceeds that required for
its diagnosis (presence of symptoms for at least 6 months), and at present GAD
is poorly recognized and is consequently often under treated.
Patients with GAD are more likely to present in a primary health care
setting than to a psychiatrist. They are likely to complain of somatic symptoms,
and may be referred
for unnecessary medical investigations.
Patients with GAD may present co-morbid mood, anxiety, or substance-use
disorders. Untreated, GAD is a chronic condition. The course is likely to
depend on co-morbid disorders. Negative life events are likely to exacerbate
symptoms. Treatment may significantly benefit patients (Robertson, Allwood and Gagiano, 2001:
148).
Barlow and Durand (1995: 164) state that many primary care physicians
treat Generalized Anxiety Disorder exclusively by prescribing anti-anxiety
medication.
However, these drugs are not without risks. They cause impairment of
cognitive functioning such as reaction time and many individuals experience
rebound anxiety if they abruptly stop taking the medications (Barlow and Durand
1995: 164).
Problem Statement
The aim of this double-blind placebo-controlled study was to evaluate
the relative efficacy of homoeopathic simillimum
treatment as compared to psychological counselling (Cognitive Therapy and
Behavioural Therapy) in the management of Generalized Anxiety Disorder, by
means of the Hamilton Anxiety Rating Scale (Appendix F), the Beck Anxiety
Inventory (Appendix G) and the Patient
Objectives of the study
The 1st objective was to determine the effectiveness of
homoeopathic simillimum treatment, psychological
counselling (Cognitive Therapy and Behavioural Therapy) and placebo in the
management of GAD signs and symptoms in terms of the Hamilton Anxiety Rating
Scale (refer Appendix F).
The 2nd objective was to determine the effectiveness of
homoeopathic simillimum treatment, psychological
counselling (Cognitive Therapy and Behavioural Therapy) and placebo in the
management of GAD signs and symptoms in terms of the Beck Anxiety Rating Scale
(refer Appendix G).
The 3rd objective was to determine the effectiveness
homoeopathic simillimum treatment, psychological
counselling (Cognitive Therapy and Behavioural Therapy) and placebo in the
management of GAD signs and symptoms in terms of the Patient Perception
Questionnaire (refer Appendix H).
The 4th objective was to compare the effectiveness of the
three groups (Simillimum group, Psychological
Counselling group and Placebo group) with each other with regard to the three
measurement tools.
1.3.1
1st hypothesis
It was hypothesized that Homoeopathic simillimum
would have no beneficial effect in the management of GAD signs and symptoms in
terms of the Hamilton Anxiety Rating Scale, the Beck Anxiety Inventory and the
Patient Perception Questionnaire.
1.3.2
2nd hypothesis
It was hypothesized that Psychological counselling would have no
beneficial effect in the management of GAD signs and symptoms in terms of the
Hamilton Anxiety Rating Scale, the Beck Anxiety Inventory and the Patient
Perception Questionnaire (refer Appendix H).
1.3.3
3rd hypothesis
It was hypothesized that Placebo would have no beneficial effect in the
management of GAD signs and symptoms in terms of the Hamilton Anxiety Rating
Scale, the Beck Anxiety Inventory and the Patient Perception Questionnaire
individual so as to be able to predict behaviour and provide a basis for future
action.
Psychometrics are tools which assist in the diagnosis of a range of
abnormal conditions (Edenborough, 1994, 1999: 1-8).
In this study the following tools were used: the Hamilton Anxiety Rating
Scale, the Beck Anxiety Inventory (Appendix G), and the Patient Perception
Questionnaire.
2.9.2
Hamilton Anxiety Rating Scale (HAM-A)
This is the standard method of assessing the effectiveness of drug
treatments in psychiatric indications, particularly anxiety and depression. The
scale is internationally recognized by drug regulatory bodies. A rating scale
that is developed to quantify the severity of anxiety symptomatology
and is often used in psychotropic drug evaluation. It consists of 14 items,
each defined by a series of symptoms. Each item is rated on a 5-point scale,
ranging from 0 (not present/ absent) to 4 (incapacitating) (Hamilton, 1959).
2.9.3
Beck Anxiety Inventory (BAI)
This scale was developed to address the need for an instrument that
would reliably discriminate anxiety from depression while displaying convergent
validity. It is also useful in differentiating between behavioural, emotional,
and physiological symptoms in individuals with anxiety and depression. It
quickly assesses the severity of patient anxiety. The scale has obtained high
international consistency and item total correlations. It is more reliable
compared to existing self-report measures, which have not yet been shown to
differentiate anxiety from depression adequately.
This scale consists of 21 items, each describing a common symptom of
anxiety The respondent is asked to rate how much he/she has been bothered by
each symptom over the past week on a 4-point scale ranging from 0 (not at all)
to 3 (severely). It is recommended for use in assessing anxiety in clinical and
research settings (Beck, Epstein, Brown and Steer, 1987: 1).
2.9.4
Patient Perception Questionnaire
Due to the descriptive nature of GAD, subjective outcome measures also
have value. It is known that the emotions of anxiety cannot be only objectively
measured.
Anxiety can also be estimated by an anxiety perception questionnaire,
which estimates the client’s current severity of GAD. Such a questionnaire also
measures the extent to which GAD affects daily
functioning and noticeability to others
(Bonne, Shemer, Gorali,
Katz and Shalev, 2003: 282-7).
The anxiety perception questionnaire used in this study is called the
Patient Perception Questionnaire, and is adapted from Morin (1993: 199).
2.10
Treatment
2.10.1
Pharmaceutical treatment
Many primary care physicians treat GAD exclusively by prescribing
anti-anxiety medication. However, these drugs are not without risks. They cause
impairment of cognitive functioning such as reaction time. Many individuals
experience rebound anxiety if they abruptly stop taking the medications. At the
present time most clinical investigators think these drugs may have some
beneficial effects in reducing anxiety over short term (4 to 8 weeks), compared
to placebo, but not over the long term (Gorman, 2002: 17).
2.10.1.1
Anxiolytics
Anti-anxiety agents (also known as anxiolytics
or minor tranquilizers) include the following classes: benzodiazepine, carbamate, azaspirodecanedione
and barbiturate.
2.10.1.1.1
Benzodiazepines became widely available in the 1960’s. They all have anxiolytic, hypnotic, anticonvulsant, and muscle relaxant
properties, which are mediated by potentiating the effect of gamma-aminobutyric acid.
Benzodiazepines are anxiolytic in patients
with GAD and have a rapid onset of action.
However, their efficacy in long-term treatment may not be as robust as
previously assumed. For example, Gorman (2002: 18) found that of patients
responding to treatment, nearly two thirds will remit and a number
of studies have indicated that, despite early improvement in anxiety
symptoms, the effects of benzodiazepines are not significantly different from
placebo after 4 to 6 weeks of treatment. Moreover, their benefit extends
primarily to relief of somatic symptoms, rather than the psychological symptoms
that include worry, a key feature of GAD (Gorman, 2002: 18).
Adverse events while on this drug include:impairment
of cognitive and mot or functioning, impairment of driving performance,
increased number of falls resulting in hip fractures in the elderly. (Barlow
and Durand, 1995: 164.)
There is also a concern that this class of drugs may lead to dependence,
resulting in withdrawal symptoms, sedation, difficulty concentrating and other
bothersome side effects (Pande, Crockatt,
Feltner, Janney, Smith, Weisler, Londborg, Bielski, Zimbroff, Davidson and
Liu-Dumaw, 2002: 533). According to Stevens and Rodin
(2001: 35-37), the benzodiazepines may produce functional changes in the
central nervous system that make it difficult for patients to withdraw from
these drugs
Binding of GABA
to the receptor on the cell membrane triggers an opening of a chloride conductance.
The influx of chloride ions causes a small hyper polarization that removes the
post-synaptic potential away from its firing threshold and thus inhibits the
formation of action potential.
The benzodiazepines bind to specific, high affinity sites on the cell
membrane, which are separate from but adjacent to the receptor for GABA.
The benzodiazepine receptors are found only in the central nervous
system (CNS), and their location parallels that of GABA neurons.
Benzodiazepines and GABA mutually increase the affinity of their binding
sites without actually changing the total number of sites (Mycek,
Harvey and Champe, 2000: 89-92).
2.10.1.1.2
Carbamate include meprobamate, ethinamate, and carisoprodol,
which have been used in the past as anxiolytics. They
have more potential for abuse and are more likely to induce dependence than the
benzodiazepines. Carbamate therapy is indicated only
when use of benzodiazepine is not possible (Fadem,
1994: 23).
2.10.1.1.3
Buspirone, an azaspirodecanedione,
are not related to the benzodiazepines. It is unique among anxiolytics
in that it is non-sedating and is not associated with dependence, abuse, or
withdrawal problems (Fadem, 1994: 23).
2.10.1.1.4
Barbiturates have a lower therapeutic index (the ratio of minimum toxic
dose to maximum effective dose) than the benzodiazepines, and have a greater
potential for abuse. Therefore, they are less frequently used as anti-anxiety
drugs. Adverse effects include sedation and respiratory depression. Overdose of
barbiturates may be lethal. Tolerance and dependence develop with chronic use (Fadem, 1994: 23).
2.10.1.2
Antidepressants and other drugs
Recently, management of GAD has shifted from benzodiazepines toward
antidepressants such as venlafaxine, driven by the
recognition that the antidepressants have anti-anxiety effects, depressive
symptoms that sometimes accompany GAD may not respond well to benzodiazepines,
and Benzodiazepines, despite their long record of safety,
do carry some risk of abuse, dependence, and associated problems such as
withdrawal effects.
However, the delayed onset of clinical effect seen with antidepressant
drugs and buspirone is a limitation and disadvantage
compared with benzodiazepines, which are rapidly effective in many GAD
patients.
Pregabalin claims to be effective, rapidly acting, and safe
treatment for GAD. In short-term treatment, pregabalin
does not appear to have the withdrawal symptoms associated with the
benzodiazepines (Pande et al., 2002: 533).
Selective Serotonin Re-uptake Inhibitors type of drugs are not
considered as frontline drugs for treating anxiety, because of their side
effects which include nausea, headaches, and sexual side effects (Pande et al., 2002: 533).
2.10.2
Psychological counseling
Kaplan and Sadock (1996: 216), state that the
major psychotherapeutic approaches to GAD are cognitive-behavioural,
supportive, and insight oriented. Data is still limited on the relative merits
of those approaches, although the most sophisticated studies have been with
cognitive-behavioural techniques, which seem to have both short-term and
long-term efficacy.
2.10.2.1
Behavioural therapy (BT) emerged in the late 1950s as an explicitly
formulated, systematized body of knowledge. It was not until the 1960s that
behaviour therapy was widely recognized as an alternative model of aetiology
and therapy to the prevailing psychodynamic approach. As a scientific approach
to human problems, behaviour therapy is characterized by an emphasis on
rigorous measurement and carefully controlled experiments both in the
laboratory and in the natural environment. An attempt is made to objectively
evaluate the results of therapeutic interventions rather than to rely primarily
on the therapist’s clinical or subjective impression of progress. The focus is
on observable and hence directly measurable behaviour (O’Leary and Wilson,
1975: 12).
One of the unique contributions of behaviour therapy is that it provides
the therapist with well-defined system of procedures to employ within the
context of a well-defined role. It also provides the client with a clear role,
and it stresses the importance of client awareness and participation in the
therapeutic process. Clients must be willing to cooperate in carrying out
therapeutic activities, both during therapy sessions and in their life. If they
are not involved in this way, the chances are slim that therapy will be
successful (Corey, 1996: 289).
Behaviour therapy targets the patient’s behaviour and emphasizes
treatment in the context of family and school instead of focusing on
intra-psychic conflict, and is combined with cognitive-behaviour therapy which
combines a behavioural approach with changing the cognitions associated with
the patient’s anxiety. The combination of these therapies has shown positive
results without the drawbacks of medication (Stevens and Rodin, 2001: 35-37).
Limitations and criticisms of behaviour therapy: behaviour therapists
need to listen very carefully to their clients and to allow them to express and
explore their feelings before implementing a treatment plan. The basic
therapeutic conditions that are stressed by the person-centred therapists such
as active listening, accurate empathy, positive regard, genuineness, respect,
and immediacy can be integrated into a behavioural framework.
However, too often counsellors are so anxious to work toward resolving
problems that they are not fully present with their clients. A mistake that
some counsellors make is focusing on the presenting issue instead of listening
to the client’s deeper message (Corey, 1996: 308).
Cognitive therapy places major emphasis on behavioural experiments i.e.,
testing one’s ideas by the scientific method. In these experiments the client
specifies clearly the belief to be tested, determines the grounds for
acceptance and rejection of the theory, performs the action, and compares the
data with those expected (Peterson, 1996:210).
Cognitive therapy seeks to:
1. Identify cognitions relevant to the presenting problem.
2. Recognize connections among cognitions, affects, and behaviours.
3. Examine the evidence for and against key beliefs.
4. Encourage the patient to try out alternative conceptualizations.
5. Teach the patient to carry out the cognitive process independently
(Schuyler, 1991: 29).
The cognitive model’s view of abnormality sees mental disorders as
resulting from disorders in people’s cognitions and thoughts. The aim of
cognitive therapy is to demonstrate to people seeking treatment that their
distorted or irrational thoughts are the main contributors to their
difficulties. If the faulty modes of thinking can be modified or changed, then
disorders can be alleviated (Gross and Mcilveen,
1996: 118).
The physiological activity of potentised
preparation lies in the crystalline structure of this water molecule and their
ability to absorb and emit radiance at specific frequencies. Dilution
progressively removes crystals containing the solute molecule and supplies a
fresh source of unstructured water. Succussion causes
new water crystals which do not contain a solute molecule to grow in the same
pattern as those containing solute molecules (Towsey
and Hasan, 1995).
Maultsby (1998) states that drugs alone cannot be the
complete and final answer to good mental health.
According to Hahnemann, “...without the most minute individualization,
homoeopathy is not conceivable.” (Hahnemann, 1995:34). Homoeopathy aims to
quickly restore the diseased patient back to his or her former healthy state,
using the least amount of remedies in the smallest dose possible.
It de-emphasizes diagnostic labelling, not because homoeopathic
physicians are incapable of speaking the medical jargon, but rather because it
is concerned with establishing a cure rather than endless speculating as to the
correct medical label for the condition. As homoeopaths use the totality of the
patient’s symptoms as guide to the remedy prescription, a medical diagnosis of
that particular group of symptoms is not a pre-requisite for treatment
(Hahnemann, 1995:34).
The homoeopathic method involves an exceptionally complete and detailed
description of the patient, the illness and its evolution. It also involves a
similarly detailed appraisal of the changes that follow the intervention. Thus
it provides an unusually full account of the phenomenon of illness and the
healing process (Swayne, 1998: 1-2).
Homoeopathic medicines are versatile; a single medicine is useful in a
number of body systems and a variety of morbidities. Homoeopathic medicines are
specific to the precise form in which any type of morbidity is experienced by
the patient (Dannheisser and Edwards, 1998:
8-11).
Homoeopathic remedies are tailored not only to the patients symptoms but
also to their personality types and to the reason they became ill. It involves
delving into the depths of human nature, and the mental/emotional makeup of the
patient. Homoeopathy improves the patient’s life on all levels. This is because
homoeopathy goes directly to the core of the person, to the body’s own natural
healing energy (The Vital Force) strengthening it and balancing it, so that not
only do the specific disease symptoms disappear, but, ideally, the entire
spiritual-mental emotional-physical being is restored (de Schepper,
2001:3-11).
The homoeopathic simillimum is that remedy
which most closely corresponds to the totality of symptoms. It is the most
similar remedy corresponding to the person, the one best covering the true
totality of symptoms. Simillimum treatment is based
on a full evaluation of the patient’s physical, emotional and mental
characteristics. This is especially effective when the disease is chronic (Lockie and Geddes, 1995:14).
The choice of the homoeopathic simillimum
(particularly for chronic conditions) rests predominantly upon the mental state
or personality subtype of the patient. Anatomical, physiological and
biochemical evidence reveals that the
body’s autonomic, endocrine and immune systems are not autonomous, but engage
in an interactive dialogue with each other and with higher perceptual and
emotional centres to maintain health and to combat disease.
Hence, it is recognized that psychological factors
(emotions/stress/distress) play a role in modulating immunity and/or disease
process (Pitts and Phillips, 1998: 61-65).
The concept of treating the whole person is an essential element of
homoeopathy. The basis of this belief is that symptoms, diseases or pains do
not exist in isolation, but are a reflection of how the person as a whole is
coping with stress. The homoeopath looks beyond the presenting complaint and the
label of the disease to the totality of symptoms the person experiences.
Healing from deep trauma comes from facing it openly and retelling the
event repeatedly, allowing natural healing mechanisms to operate that are
capable of dealing with emotional damage caused by trauma.
Such healing mechanisms include crying, laughing and angry raging (Bogorad, 2003)
The correct homoeopathic medicine must accurately reflect the experience
of the illness in the individual patient and the individual characteristics of
the patient him or herself (Swayne, 1998: 22)
Human nature is one that seeks pleasure and gratification, so the
discomfort and the pain involved in solving problems is avoided as far as
possible. Often a person will go to great lengths to avoid such pain, even as
far as constructing fantasies in which to live, sometimes to the total
exclusion of reality (Peck, 1978).
2.10.3.1
The efficacy of homoeopathic treatment of GAD
According to Sankaran (1994:11-15) a
homoeopathic prescription is designed to correct the psychoneuro-endocrine-immunological
(P.N.E.I.) or psychogenic disturbance, facilitating improvement of the
patient’s condition. These four systems are intricately connected to each
other, so that specific changes in the psyche can be associated with specific
symptoms in the N.E.I. systems, and these systems form together one axis,
namely the P.N.E.I. axis (Sankaran,1991: 37).
From the above, one can understand homoeopathy’s possible affinity for
treating GAD.
A randomized, double blind, placebo-controlled study of Classical
homoeopathy in GAD done in Israel in 2003 had positive results in managing GAD,
where forty four patients participated in a
10 week trial of individually tailored homoeopathic remedies.
39 patients completed the study (20 in the active treatment group and 19
in the placebo group). Subject’s symptoms were rated before treatment and after
5 and 10 weeks of treatment, with the Hamilton Rating Scale for Anxiety (HAM-A)
as the main outcome measure.
Additional measures of outcome included the Brief Symptom Inventory, the
Psychological General Well-Being Index, and the Hamilton Rating Scale for
Depression, the Beck Depression Inventory,
Spielberger’s State-Trait Anxiety Inventory, and a Visual
Analogue Scale of subjective distress (Bonne et al., 2003: 282-7).
Positive results were observed for both groups. The conclusion was that
the effect of homoeopathic treatment on mental symptoms of patients with GAD
did not differ from that of placebo.
The improvement in both groups however, was substantial (Bonne et al.,
2003: 282-7).
A clinical trial to establish the effectiveness of homoeopathic
treatment in conjunction with Rational Behaviour Therapy in the treatment of dysthymic and adjustment disorder was conducted by Louw (2003). This was a double blind clinical trial, which
included both quantitative and qualitative methods of analysis. A placebo group
was compared with a treatment group, in order to establish whether or not
homoeopathic treatment of dysthymic and adjustment
disorder, in conjunction with rational behaviour therapy, altered patient score
ratings in terms of scales. A total of 18 participants entered the study.
The participants were divided into two groups i.e. treatment group
(homoeopathic consultations, homoeopathic simillimum
powders and rational behaviour group therapy) and placebo group (homoeopathic
consultations, placebo powders and rational behaviour group therapy).
16 participants completed the 9 - week trial, which included 16 hours of
rational behaviour group therapy and a varying number of homoeopathic
consultations.
Evaluation was by means of the Beck Depression Inventory and the YUPI
Scale.
The results according to the Wilcoxon Signed
Rank Test (Intra-group analysis) in the Simillimum
group for the comparison of the pre and post treatment using the Beck
Depression Inventory showed a test score of 0,010 that indicated a
statistically significant difference in severity of depression between the
first and final treatments.
The Placebo group results according to the Wilcoxon
Signed Rank Test (Intra-group analysis) for the comparison of the pre and post
treatment using the Beck Depression Inventory showed a test score of 0,014 that
indicated a statistically significant difference in severity of depression
between the first and final treatments.
Whereas the results according to the Wilcoxon
Signed Rank Test (Intra-group analysis) for the comparison of the pre and post
treatment using the YUPI Inventory –Part A,
in the Simillimum group showed a test score of
0,017 that indicated a statistically significant difference in common sense perceptional level between the first and final treatments.
However, there was no statistically significant difference in the placebo group
as the results showed a test score of 0,050.
YUPI Inventory – Part B, in the Simillimum
group showed a test score of 0,012 that indicated a statistically significant
difference in patient beliefs between the first and final treatments. However,
there was no statistically significant difference in the placebo group as the
results showed a test score of 0,123.
Homoeopathic simillimum in conjunction with
rational behaviour therapy proved statistically superior to placebo in
conjunction with rational behaviour therapy in patients with dysthymic and adjustment disorder regarding patients’
ability to deal with cognitive distortions during therapy.
Power, Simpson, Swanson and Wallace (1990: 267 -292) conducted a study
comparing cognitive-behavioural therapy, diazepam and placebo, alone and in combination,
in the treatment of GAD. The results demonstrated that the greatest amount of
positive changes was produced by cognitive-behavioural treatment and
cognitive-behavioural treatment combined with medication.
Borkovec and Castello (1993:
611-619), compared the effectiveness of three treatments for GAD: Nondirective
therapy, Applied Relaxation and Cognitive Behavioural Therapy.
Effectiveness based on clinicians’ratings of
their clients’ level of anxiety both before and after the different therapies.
Although improvement was evident among all participants, those in the applied
relaxation and cognitive-behavioural treatments showed superior gains. However,
no p-values were provided, and there was no placebo group, so it is difficult
to objectively evaluate these results.
2.11
The placebo effect
Placebo is a substance with no active biological properties. In a
controlled clinical trial, it is used as an inactive agent that plays the role
of a standard of comparison for the substance or method to be tested and is
indistinguishable from it (Swayne, 2000: 162).
There are a number of factors that contribute to the placebo effect.
(1) nature of the intervention e.g. injections vs. pills, the use of
hi-tech approaches (ultra sound), the colour of the medication or the unusual
nature of the therapeutic encounter (homoeopathic consultation).
(2) The nature of the therapist e.g. confidence, demeanour, empathy,
warmth, reputation and prestige. (3) The time factor involved - the longer the
consultation the better the placebo effect. (4)
The patient, their trust in the therapist and their worldviews. (5) The
nature of the complaint. (6) The therapeutic setting (Peters, 2001: 25).
The placebo effect dates back to Hippocrates who observed that certain
gravely ill people seemed to recover through sheer “contentment”. Placebo
accounts for much of the benefit from anti-depressants and all the benefit from
antibiotics taken for viral infections, which are not affected by the drug
(Grady, 2004: 10).
The placebo effect is powerful. Examples cited by Hawkins (2001: 72)
include (1) the use of saline injection for acute pain, (2) the placebo
component of anti-depressants being nearly twice as powerful as the
pharmacological component, (3) and the 2.5 time greater death rate over a years
follow up for post-myocardial infarction patients who took their prescribed
placebo medicine irregularly as compared to those who took it regularly.
According to Benson and Friedman (1996: 194-195), the placebo is the
aspect of treatment not attributable to specific pharmacologic or physiologic
properties. They have proposed that the determinants of the placebo effect are
a positive belief and expectation on the part of the patient, a positive belief
and a positive belief of expectation on the part of the physician, and a good
relationship existing between both the patient and physician
2.12
Conclusion
Pharmaceutical treatments available for GAD appear not to be maintaining
long-term resolution of symptoms, with mainstream treatment being aimed largely
at the biological level of symptom management.
Whilst these mood-altering substances have no doubt saved lives or
brought transient relief to some patients, they do not seem to provide
long-term benefits (Pande et al. , 2002: 533).
Homoeopathic treatment recognizes the complexity and individuality of
the patient suffering from GAD so it is suitable for treatment of GAD. A
clinical trial of the homoeopathic simillimum
treatment of GAD has already been conducted (Bonne et al., 2003).
This study aims to extend knowledge regarding homoeopathy and the
treatment of GAD.
The diagnostic criteria were:
A. 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).
B. The person finds it difficult to control the worry.
C. The anxiety and worry are associated with three (or more) of the
following six symptoms ( with at least some symptoms present for more days for
the past 6 months):
o Restlessness or feeling keyed up or on edge;
o Being easily fatigued;
o Difficulty concentrating or mind going blank;
o Irritability;
o Muscle tension;
o Sleep disturbance difficulty falling or staying asleep or restless;
(unsatisfying sleep).
D. The focus of the anxiety and worry is not confined to features of an
AXIS I Disorder, e.g., the anxiety or worry is not about having a panic attack
(as in Panic Disorder ), being
embarrassed in public (as in Social Phobia), being contaminated (as in
Obsessive Compulsive Disorder), being away from home or close relatives (as in
Separation Anxiety Disorder),
gaining weight (as in Anorexia Nervosa), having multiple physical
complaints (as in Somatisation Disorder), or having serious illness(as in Hypochondriasis), and the anxiety and worry
do not occur exclusively during Post-traumatic Stress Disorder.
E. The anxiety, worry or physical symptoms cause clinically significant
distress or impairment in social, occupational, or other important areas of
functioning.
F. The disturbance is not due to the direct physiological effects of a
substance (e.g. a drug of abuse, a medication) or a general medical condition
(e.g., hyperthyroidism) and does not
occur exclusively during a Mood Disorder, a Psychotic Disorder, or a
Passive Developmental Disorder.
4. Participants had to be willing to not change their lifestyle and
eating habits for the duration of the trial period.
5. They had to be literate to understand and fill in questionnaires
(English or Zulu).
6. Participants had to be from the Greater Durban area with access to
the Durban Institute of Technology (DIT) Homoeopathic Day