Anxiety Treatment

What is Anxiety

We all have anxiety. Without it, we would lack motivation and initiative. All too often, the word anxiety elicits a negative connotation. If for example, a student who is worried about not doing well on an upcoming examination is prompted to study hard for a test due to feeling anxious and gets an “A” on the examination, then obviously anxiety was good. Using the same example, if the student gets so distressed and worried about the examination that he or she cannot focus or concentrate or “blanks out” when the examination is presented and winds up failing, then it can be accurately concluded that the student has a clinically diagnosable issue with Anxiety.

Anxiety disorder must involve major interference in carrying out the normal activities of daily living. The concept of anxiety is on a spectrum, ranging from promoting productivity and success to debilitating worry and fear which renders the victim unable to carry out even simple tasks.

Anxiety is a normal reaction to stressful situations or people. It can alert us to dangers and help us prepare and pay attention. Anxiety disorders differ from normal feelings of nervousness or anxiousness and involve excessive fear or worry. Anxiety disorders are the most common of mental disorders and affect nearly 30% of adults at some point in their lives. But anxiety disorders are highly treatable, and there are many highly effective treatments available.

How Common Are Anxiety Disorders

In any given year the estimated percent of U.S. adults with various anxiety disorders are:

specific phobia: 7% to 9%
social anxiety disorder: 7%
panic disorder: 2% - 3%
agoraphobia: 2%
generalized anxiety disorder: 2%
separation anxiety disorder: 1% - 2%

Women are more likely than men to experience anxiety disorders.

Anxiety refers to anticipation of a future concern and is associated with muscle tension headaches, gastro-intestinal issues, sleep disturbances and avoidance behavior. Fear is an emotional response to an immediate threat and is associated with a fight or flight reaction – either staying to fight or leaving to escape danger. Freeze is the other option, a reaction that renders a people motionless to danger.

Anxiety disorders can cause people to try to avoid situations that trigger or worsen their symptoms. Job performance, academic challenges and personal relationships can be adversely affected.

In general, for a person to be diagnosed with an anxiety disorder, the fear or anxiety must:

Be out of proportion to the situation, i.e., overreaction
Hinder the ability to function effectively
Involve excessive worry which often leads to rumination and perseveration.
Cause unpleasant physical symptoms

There are several types of anxiety disorders, including generalized anxiety disorder, panic disorder, specific phobias, agoraphobia, social anxiety disorder and separation anxiety disorder.

Types of Anxiety Disorders:

Generalized Anxiety Disorder

Generalized anxiety disorder involves persistent and excessive worry that interferes with daily activities. This ongoing worry and tension may be accompanied by physical symptoms, such as restlessness, feeling on edge or easily fatigued, difficulty concentrating, muscle tension or problems sleeping. Often the worries focus on everyday things such as job responsibilities, family health or minor matters such as chores, car repairs, or appointments. Anxiety causes a person to feel on “edge” and to have difficulty in concentrating or staying focused. Completing projects or assignments may be especially challenging.

Panic Disorder

The core symptom of panic disorder is recurrent panic attacks, an overwhelming combination of physical and psychological distress. During an attack several of these symptoms occur in combination:

Palpitations, pounding heart or rapid heart rate
Sweating
Trembling or shaking
Feeling of shortness of breath or smothering sensations
Chest pain
Feeling dizzy, light-headed or faint
Feeling of choking
Numbness or tingling
Chills or hot flashes
Nausea or abdominal pains
Feeling detached
Fear of losing control of one’s emotions
Fear of death

Because symptoms are so severe, many people who experience a panic attack may believe they are having a heart attack or other life-threatening illness and may go to a hospital emergency room. Panic attacks may occur unexpectedly and can be frightening for the victim. The mean age for onset of panic disorder is 22-23. Panic attacks may occur with other mental disorders such as depression or PTSD.

Phobias, Specific Phobia

A specific phobia is excessive and persistent fear of a specific object, situation or activity that is generally not harmful. Patients know their fear is excessive, but they are unable to overcome it. These fears cause such distress that some people go to extreme lengths to avoid what they fear. Examples are fear of flying or fear of spiders.

Agoraphobia

Agoraphobia is the fear of being in situations where escape may be difficult or embarrassing, or help might not be available in the event of panic symptoms. The fear is out of proportion to the actual situation and lasts generally six months or more and causes problems in functioning. A person with agoraphobia experiences this fear in two or more of the following situations:

Using public transportation
Being in open spaces
Being in enclosed places
Standing in line or being in a crowd
Being outside the home alone

Untreated agoraphobia can become so serious that a person may be unable to leave the house. A person can only be diagnosed with agoraphobia if the fear is intensely upsetting, or if it significantly interferes with normal daily activities.

Social Anxiety Disorder (previously called social phobia)

A person with social anxiety disorder has significant anxiety and discomfort about being embarrassed, humiliated, rejected or looked down on in social interactions. People with this disorder will try to avoid the situation or endure it with great anxiety. Common examples are extreme fear of public speaking, meeting new people or eating/drinking in public. The fear or anxiety causes problems with daily functioning and lasts at least six months.

Separation Anxiety Disorder

A person with separation anxiety disorder is excessively fearful or anxious about separation from those with whom he or she is attached. The feeling is beyond what is appropriate for the person’s age, persists (at least four weeks in children and six months in adults) and causes problems functioning. A person with separation anxiety disorder may be persistently worried about losing the person closest to him or her, may be reluctant or refuse to go out or sleep away from home or without that person, or may experience nightmares about separation. Physical symptoms of distress often develop in childhood, but symptoms can carry though adulthood.

Risk Factors

The causes of anxiety disorders are currently unknown but likely involve a combination of factors including genetic, environmental, psychological, and developmental. Anxiety disorders can run in families, suggesting that a combination of genes and environmental stresses can produce the disorders.

Diagnosis and Treatment

The first step is to see your doctor to make sure there is no physical problem causing the symptoms. If an anxiety disorder is diagnosed, a mental health professional can work with you on the best treatment. Unfortunately, many people with anxiety disorders do not seek help.

Although each anxiety disorder has unique characteristics, most people respond well to two types of treatment: psychotherapy, or “talk therapy,” and medications. These treatments can be given alone or in combination. Cognitive behavior therapy (CBT), a type of talk therapy, can help a person learn a different way of thinking, reacting, and behaving to help feel less anxious. Medications will not cure anxiety disorders but can give significant relief from symptoms. The most commonly used medications are anti-anxiety medications (generally prescribed only for a short period of time) and antidepressants. Beta-blockers, used for heart conditions, are sometimes used to control physical symptoms of anxiety.

Self-Help, Coping, and Managing

There are any number of things people do to help cope with symptoms of anxiety disorders and make treatment more effective. Stress management techniques and meditation can be helpful. Support groups (in-person or online) can provide an opportunity to share experiences and coping strategies. Learning more about the specifics of a disorder and helping family and friends to understand better can also be helpful. Avoid caffeine, which can worsen symptoms, and check with your doctor about any medications.

Physician Review By:
Ranna Parekh, M.D., M.P.H.
January 2017
Retrieved from the American Psychiatric Website on 2/16/2021

About the Clinician:

I am a highly trained clinician with a vast amount of clinical experience in treating PTSD.

I have successfully treated clients with careers in law enforcement, firefighting, military, health care and other professions which are inherently stressful. I specialize in treating clients with PTSD, having many years of experience in treating clients with acute or chronic PTSD symptoms. I have extensive training in Crisis Intervention, Trauma Focused-Cognitive Behavior Therapy, Eye Movement Desensitization Reprocessing (EMDR), Problem Solving, Dialectical Behavior Therapy and Cognitive Behavior Therapy. I also use Short Term Solution Focused Therapy as well as Existentialism. I graduated with a Master of Social Work degree from Ohio State University, Clinical Track. I was also trained by the FBI and Columbus Ohio Police Department in Crisis Interventions and Crisis Management.

I have been able to help numerous clients work through and overcome PTSD. I have been counseling clients since 1994. I used to do short-term counseling in the FBI through their Employee Assistance Program. Since 2013, I have been counseling patients in inpatient crisis units as well as in private practice outpatient settings. I did my clinical internship at Ohio State University Medical Center (Harding Hospital, which is a psychiatric wing of the medical center). I learned how to deal with patients who are actively suicidal or who attempted suicide. I learned many useful crisis intervention skills which I have been able to apply in my clinical practice.