Anxiety disorders

Anxiety disorders are conditions in which fear, anxiety, stress or other forms of abnormal and lasting anxiety are the main symptoms. These symptoms may be more or less disabling, depending on their intensity and sensitivity to daily life events. In the most serious cases, the level of suffering and disability can be very high. Unlike psychoses, anxiety disorders do not alter the subject’s contact with reality: sufferers are aware of their excessive fear and may question their behaviour after their anxiety level has returned to normal. However, sufferers cannot fight against the anguish and its consequences when they are confronted with them. The severity of anxiety disorders is also due to their potential complications, mainly depression, which occurs in about 50% of cases, and addictions, especially to alcohol or sedative medication (about 20%).

The main anxiety disorders are agoraphobia, panic disorder, simple phobias, social phobia (or anxiety), generalised anxiety disorder (GAD) and post-traumatic stress disorder (PTSD) that affects the victims or witnesses of serious trauma (physical violence, accidents, wars, etc.). Anxiety disorders are often chronic in nature, which means they can persist over the long term if they are not diagnosed and treated rapidly. For more than half of those affected, there is an increased risk of developing a lifelong depressive state, but also an increased risk of social withdrawal or suicide.

Anxiety disorders are the most common psychiatric illnesses: if we consider the general population aged 18 to 65 over a year, 15% of individuals will develop an anxiety disorder (one-year prevalence), while 27% will present an anxiety disorder at some point in their lives (lifetime prevalence). In Switzerland, there are 1 million people suffering from anxiety disorders each year, which represents an estimated human, medical and economic cost of 1.5 billion euros. The majority are women, with about 1.5 to 2 women affected for every man. They mainly concern young adults, since the 25 to 44 age group is the most affected; however, anxiety disorders can occur at all ages, including young children and the elderly.

The early recognition of disorders and the implementation of available treatments are a major challenge to prevent its chronic development. Raising awareness among the population and health professionals is therefore fundamental. At present, the management of anxiety disorders is based on psychoeducation (information transmitted on the aetiology, psychological mechanisms and existing treatments that should be offered to all patients), psychotherapy and pharmacotherapy. Although effective, current drug therapies are associated with a risk of dependence that limits their long-term use.

Treatments - the promise of research:

In terms of research, several innovative approaches offer hope for new therapeutic advances:

tDCS (transcranial direct current stimulation) is a promising technique. It consists of stimulating the brain with a non-invasive electric current and aims to modify the plasticity of brain networks involved in the control of emotions and anxiety. When used in conjunction with cognitive psychotherapies, it may potentiate the beneficial effects of these existing interventions. However, the technique has never been rigorously tested in anxious patients.

The development of virtual reality is also a promising approach, particularly in the treatment of post-traumatic stress disorder and phobias. It allows the subject to confront phobogenic situations in a fictional and safe context and facilitates the implementation of learning and compensatory strategies that will allow the subject to reduce their symptoms.

Neurofeedback records the activity of target brain regions and allows the patient to develop appropriate cognitive strategies that will decrease or increase the activity of the target regions.

Some drug therapies such as D-cycloserine may increase the benefit of these new treatments or existing cognitive therapies.

The development of “serious games” also offers a promising avenue for research. It promotes psycho-education and information, especially among young populations who are also affected by anxiety disorders, sometimes at an early age or when cognitive defences are not yet in place. It can also reduce the social stigma associated with anxiety disorders and in doing so promotes dialogue, access to treatment and patient-caregiver interactions.