Anxiety is a mind/body response to a perceived threat to our physical or psychological survival or wellbeing. Mother nature has created an exquisite system of evolutionary responses to help us remain viable as an organism. One of the downsides of being human is our susceptibility to remaining in an ongoing state of arousal that can be debilitating. Anxiety keeps us in conflict with ourselves and with our relationships. Anxiety comes in several different forms and levels of severity. Debilitating anxiety is one of the most common symptoms we treat at Affordable Quality Counseling. Below are common types of anxiety that have been indented and are successfully treated.
Generalized Anxiety Disorder (GAD)
We all feel anxious or worry sometimes, but people who suffer from GAD worry to the point of making life unbearable or unmanageable. They generally feel that something terrible will happen to them or the people close to them. They suffer from catastrophic thinking about health, money, family and they see the world around them as dangerous. Unlike panic, they do not avoid places and situations and they do realize that their vicious cycle of worry is unwarranted.
GAD has a genetic component and is found in 2.8-3 % of the population, with twice as many women than men with the condition. It can start in anywhere from childhood into early adulthood and can come and go throughout one’s life. It can be accompanied by other conditions like depression or substance abuse.
- Difficulty concentrating
- Shortness of breath
- Frequent urination
- Startle response
- Lumps in throat
- Knots in stomach or chest
- Muscle tension
Generalized anxiety often co-exists with depression, substance abuse, or post-traumatic stress. Other conditions associated with stress, such as irritable bowel syndrome, often accompany GAD. Patients with physical symptoms, such as insomnia or headaches, should also tell their doctors about their feelings of worry and tension.
Obsessive Compulsive Disorder (OCD)
People with OCD have unwanted thoughts (obsessions) and compulsions (rituals) that interfere with their ability to manage normal everyday living. Recurrent thoughts and/or behaviors become invasive and drive the person to extraordinary lengths to accomplish them, but only provide temporary relief. Becoming obsessed with a person, place or thing, or excessive hand washing, counting or excessive masturbation are all behavioral examples. People are generally aware of these compulsions but are unable to control them without professional help.
OCD is found in about 2.3% (5 million) Americans. It can start in adolescence or early adulthood, affecting both men and women equally. Left untreated, obsessions, and the need to perform rituals, can take over a person’s life. OCD is often a chronic, relapsing illness. The cause of OCD is not determined. Genetics play a part as well as life experiences that may make a person more vulnerable to the condition.
OCD is sometimes accompanied by depression, eating disorders, substance abuse, attention deficit hyperactivity disorder, or other anxiety disorders. When a person also has other disorders, symptoms of OCD can also co-exist and may even be part of a spectrum of neurological disorders, such as Tourette’s syndrome.
- Fear of contamination or germs
- Serious doubts about one’s safety, doing harm, or being harmed
- An abnormal need for order, precision and symmetry
- Fear of making mistakes
- Fear of behaving in a socially unacceptable manner (sexual acting out)
Repetitive behaviors or mental acts in response to obsessions such as:
- Hand washing
- Checking and rechecking that something has been done
- Arranging objects over and over
Successful treatments for OCD have included both behavioral therapy known as “exposure and response prevention” and certain antidepressant medications. In this approach, a person is deliberately and voluntarily exposed to whatever triggers the obsessive thoughts and, then, is taught techniques to avoid performing the compulsive rituals and to deal with the anxiety.
Anxiety and Panic Disorder
Panic disorder is characterized by unexpected and repeated episodes of intense fear accompanied by physical and emotional symptoms of distress. About 2 percent of the population experience anxiety/panic attacks. These sensations often mimic symptoms of a heart attack or other life-threatening medical conditions. As a result, the diagnosis of panic disorder is frequently not made until cardiac screenings fail to provide a correct diagnosis or relief.
Many people with panic disorder develop intense anxiety between episodes, worrying when and where the next one will strike. It is important to note that anxiety and/or panic attacks are always time limited. It will end. No one ever died from an anxiety/panic attack, even people with heart conditions. They are uncomfortable, but not dangerous or life threatening. Anxiety/panic attacks are manageable.
Fortunately, through research supported by the National Institute of Mental Health (NIMH), effective treatments have been developed to help people with panic disorder.
- Heart palpitations – by client report
- Fear of dying
- Fears of terror and unreality
- Shortness of breath, dizziness, sweating
- De-realization (unreality) or depersonalization (detachment from self) – by client report
- Trembling, shaking, sweating
- Fear of losing control – by client report
- Chest Pressure
- Tingling or numbness in hands or feet
- Excessive and uncontrollable worry occurring more days than not
- Restlessness (e.g. inability to sit calmly in chair or stand in one place)
- Easily fatigued (e.g. abnormally tired after walking or exercise)
- Difficulty concentrating (e.g. forgetting current conversation)
- Fear/avoidance (e.g. fear of places and things)
- Irritability (e.g. clinching hands, tone of voice, shouting)
- Muscle tension (e.g. clinching hands or jaw)
- Disturbed sleep (e.g. sleep an hour, awake for two, sleep an hour)
Ways to Manage Panic/Anxiety Attacks
- Let go and wait. Don’t try to make it stop. Let it pass and wait it will go away.
- Breathe better. Deep breathing exercises will change anxiety chemicals in your body. Inhale and exhale in big slow breaths. Relax on the exhale.
- Energetic physical activity will reduce anxiety, producing chemicals in your body, so get out there and play hard.
- Distract yourself. Do an activity that is involving to help you forget about the anxiety.
- Think better. Use planned phrases to change your thoughts such as, “This is uncomfortable, but I will get through it. It is temporary. I can, and will, get through this.”
- Talk to someone during the attack and express your thoughts and feelings about the situation.
- Try meditation, yoga, or finding a quiet place just to have quiet time.
- Use your muscles. Tense up all your muscles and then let them relax.
- Find a reason to laugh. You can use books, movies, comics or friends.
- Praise yourself. When you practice or use strategies, give yourself a pat on the back. You did a good job! Keep it up.
Things to keep in mind
Practicing strategies, preparing to use strategies and knowing what situations sets you off will help you overcome your anxiety/panic attacks.
How Common is Panic?
- In a given year, 1.7% of the U.S. population (2.4 million Americans) experience panic disorder.
- Women are twice as likely as men to develop panic disorder.
- Panic disorder typically strikes in young adulthood. Roughly half of all people who have panic disorder develop the condition before age 24.
What Causes Panic Disorder?
Heredity, other biological factors, stressful life events, and thinking in a way that exaggerates relatively normal bodily reactions in catastrophic events are all believed to play a role in the onset of panic disorder. Some research suggests panic attacks occur when a “suffocation alarm mechanism” in the brain erroneously fires, falsely reporting that death is imminent. The exact cause or causes of panic disorder are unknown and are the subject of intense scientific investigation.
What Treatments Are Available for Panic Disorder?
Treatment for panic disorder includes medications and a type of psychotherapy known as cognitive-behavioral therapy, which teaches people how to view panic attacks differently and demonstrates ways to reduce anxiety. The National Institute of Mental Health (NIMH) is conducting a large-scale study to evaluate the effectiveness of combining these treatments. Appropriate treatment by an experienced professional can reduce or prevent panic attacks in 70% to 90% of people with panic disorder. Most patients show significant progress after a few weeks of therapy. Relapses may occur, but they can often be effectively treated just like the initial episode.
Can People with Panic Disorder Also Have Other Physical and Emotional Illness?
Research shows that panic disorder can co-exist with other disorders, most often depression and substance abuse. About 30% of people with a panic disorder use alcohol and 17% use drugs, such as cocaine and marijuana, in unsuccessful attempts to alleviate the anguish and distress caused by their condition. Appropriate diagnosis and treatment of other disorders such as substance abuse or depression are important to successfully treat panic disorder. Approximately 20% of people with panic disorder attempt suicide.
It is not unusual for a person with panic disorder to develop phobias about places or situations where panic attacks have occurred, such as in supermarkets or other everyday situations. As the frequency of panic attacks increases, the person often begins to avoid situations where they fear another attack may occur or where help would not be immediately available. This avoidance may eventually develop into agoraphobia, an inability to go beyond known and safe surroundings because of intense fear and anxiety.
People with panic disorder may also have irritable bowel syndrome, characterized by intermittent bouts of gastrointestinal cramps and diarrhea or constipation, or a relatively minor heart problem called mitral valve prolapse. In fact, panic disorder often co-exists with unexplained medical problems, such as chest pain not associated with a heart attack or chronic fatigue.
The content of this fact sheet was adapted from material published by the National Institute of Mental Health.
For additional resources, please call 1-8OO-969-NMHA
Other Resources: National Institute of Mental Health 1-866-615-6464 NIMH Information Center
Everyone feels anxious or uneasy from time to time. Your first day on a new job, planning for a long trip, going to the dentist your palms sweat, you feel shaky, your heart pounds. Some anxiety helps to keep you focused on the job at hand. However, when your anxiety is so serious that it interferes with your work, leads you to avoid certain situations or keeps you from enjoying life, you may be suffering from a form of the most common type of mental disorder: an anxiety disorder.
Anxiety disorders are not just a case of “nerves.” You can’t overcome an anxiety disorder just through willpower, nor can the symptoms be ignored or wished away. These disorders cause you to feel anxious most of the time, making some everyday situations so uncomfortable that you may avoid them entirely. Or, you may experience occasional instances of anxiety that are so terrifying and intense that you may be immobilized with fear.
Although these conditions can be very frightening and disabling, they are also very treatable. It is important to recognize the symptoms and seek help.
Specifically, phobias afflict as many as 12% of all Americans. They are the most common psychiatric illness in women and the second most common in men over age 25. Phobias are not all the same. There are three main groups that include:
- Specific (simple) phobias, which are the most common and focus on specific objects;
- Social phobia, which causes extreme anxiety in social or public situations;
- Agoraphobia (see explanation below)
Agoraphobia causes people to suffer anxiety about being in places or situations from which it might be difficult or embarrassing to escape—such as being in a room full of people or in an elevator. In some cases, panic attacks can become so debilitating that the person may develop agoraphobia because they fear another panic attack. In extreme cases, a person with agoraphobia may be afraid to leave their house.
Specific or simple phobias produce intense fear of a particular object or situation that is, in fact, relatively safe. People who suffer from specific phobias are aware that their fear is irrational, but the thought of facing the object or situation often brings on a panic attack or severe anxiety.
Specific phobias strike more than 1 in 10 people. No one knows what causes them, though they seem to run in families and are slightly more prevalent in women. Specific phobias usually begin in adolescence or adulthood. They start suddenly and tend to be more persistent than childhood phobias; only about 20 percent of adult phobias vanish on their own. When children have specific phobias—for example, a fear of animals, those fears usually disappear over time, though they may continue into adulthood. No one knows why they persist in some people and disappear in others.
Examples of Specific Phobias
- Persistent fear of dogs
- Insects or snakes
- Driving a car
- Tunnels or bridges
Social Phobia/Social Anxiety Disorder
Social phobia is characterized by overwhelming anxiety and excessive self-consciousness in everyday social situations. In severe forms, it can severely impair the individual’s quality of life. Socially anxious people have intense chronic fears of being watched, judged and criticized by other people that lead to feelings of embarrassment, inadequacy, depression and humiliation.
Research indicates that socially anxious people are less likely to marry than other people, may have additional occupational difficulties, may not be able to function well academically or finish school and may have a hard time making and keeping friends. Socially anxious people usually realize that their fears may be excessive but are unable on their own to overcome them. They tend to avoid dreaded social situations whenever possible or tolerate them with great discomfort.
A specific social anxiety is limited to only one type of situation such as a fear of speaking in formal or informal situations. People who have generalized social anxiety usually experience symptoms almost anytime they are around people.
3.7 % (5.3 million Americans) of the U. S. population suffer from social phobia, and it is the third most prevalent mental health problem, behind depression and substance abuse, in the United States. It usually develops early in childhood or adolescents and rarely in adults. Women suffer two times more often than men.
The symptoms of social phobia can be heart palpitations, blushing, sweating, trembling, nausea and intestinal upset. It is common to feel concerns about loss of bladder or bowel control or frequently feeling that their minds are going blank.
Socially anxious people tend to ruminate on their fear so that the anxiety about feeling the feelings may make the symptoms worse.
Social phobias do run in families and may have both a genetic and environmental component.
Treatment, including cognitive-behavioral therapy and in some cases medication, is found to be quite successful, along with supportive therapy and social skills training. Treatment usually includes a component of graded exposure to help the person overcome their feared situations.
Social phobia can produce a fear of being humiliated or embarrassed in front of other people. This problem may also be related to feelings of inferiority and low self-esteem, and can drive a person to drop out of school, avoid making friends and remain unemployed.
Although this disorder is sometimes thought to be shyness, it is not the same thing. Shy people do not experience extreme anxiety in social situations, nor do they necessarily avoid them. In contrast, people with social phobia can be at ease with people most of the time, except in particular situations. Often social phobia is accompanied by depression or substance abuse.
Social Phobia Symptoms
- View small mistakes as more exaggerated than they really are.
- Find blushing to be painfully embarrassing and feel that all eyes are on them.
- Fear speaking in public, dating, or talking with persons in authority.
- Fear using public restrooms or eating out.
- Fear talking on the phone or writing in front of others.
There is hope. No one should have to endure the terror of phobias or the unrelenting anticipatory anxiety that often accompanies them. Phobias can be overcome with proper treatment.
Treatment for Phobias
- A person suffering from a phobia is suffering from a diagnosable illness, and mental health professionals take this illness very seriously.
- A complete medical and psychiatric evaluation should be conducted by a licensed physician or psychologist to obtain an accurate diagnosis and ensure that the symptoms are not being caused by another condition.
- It is crucial to comply with treatment, and to work closely with the therapist in order to achieve success.
- Behavioral therapy and cognitive-behavioral therapy are very effective in treating these disorders.
- Behavioral therapy focuses on changing specific actions and uses different techniques to stop this behavior. One technique involves diaphragmatic breathing, which is a form of deep-breathing. Another technique, called exposure therapy, gradually exposes the patient to the object or situation which frightens him/her and helps the patient to develop coping skills.
- Cognitive-behavioral therapy teaches the persons new skills in order to react differently to the situations which trigger the anxiety or panic attacks. Patients also learn to understand how their thinking patterns contribute to the symptoms and how to change their thinking to reduce or stop these symptoms.
For More Information:
Contact your local Mental Health Association, community mental health center, or
International Mental Health Association 703/684-7722 Fax 703/684-5968.
Treating Anxiety Disorder
It is important to get a good physical examination, especially if you are using prescribed medications as well as alcohol or other substances to cope with the anxiety. Once health issues have been cleared, psychotherapy can successfully resolve or reduce anxiety conditions.
For GAD, cognitive-behavioral therapy has been found to be very effective in helping you see things in a news perspective, thus relieving catastrophic thinking. Dr. Paul Standal can help you learn essential strategies for relaxing and quieting your mind and body and to establish a peaceful place within yourself
Medications, particularly antidepressants (serotonin reuptake inhibitors) are especially effective for reducing symptoms of anxiety.
Additional Self-Help Suggestions
- Remember to breath: When we are under stress, we will breathe shallowly as a response. Our shallow breathing re-stimulates our flight, fight or freeze responses to distress, which increases our symptoms. So breathing fully and deeply, relaxed on the exhale, is a wonderful way to manage all forms of anxiety.
- When negative or intrusive thoughts and images come up, allow yourself to engage the feeling or image for a short period of time or until the anxiety gets to be too much. Systematic exposure to past traumatic events helps reduce the symptoms of anxiety.
- Give yourself positive self-talk and monitor any negative ones.
- Plan small acts of self-care daily. Listen to music, sing, and read positive books. Make sure that you act in your own healthy self-interest.
- Make a reasonable list of things to do and break them down into manageable tasks, and then go about doing them one by one. Make sure you reward yourself with each task completed.
- Rest when tired. Get a good night’s sleep when stressed or anxious.
- Eat a healthy balanced diet, eating 5 smaller meals per day.
- Avoid alcohol and drugs as techniques of reducing anxiety to an optimum level.
- Make a contract.
- Find out what the problem is – define problem.
- How have you/he/she handled the problem before?
- Research solutions and options.