ANXIETY
By Mickey Skidmore, ACSW

It is a widely accepted statistic, that one out of every five people (or 20%) will experience “clinical depression” at some point in their lives. In fact, there has probably been more research done on depression and more known about depressive disorders than any other psychiatric problem. However, many people do not differentiate anxiety from depression. While anxiety is sometimes an aspect or feature of depressive conditions, making a casual association between anxiety and depression is for the most part an over-simplification. In an effort to better educate the public, this “perspective” will emphasize the distinct nature of Anxiety Afflictions and some of the available treatments.

According to the National Institute of Mental Health, more than 23 million Americans (13%) suffer from anxiety disorders, making them among the most common mental health afflictions in the United States.

Panic Disorder

A man is rushed to a hospital emergency room with symptoms thought to be that of a heart attack, but the doctors find nothing physically wrong with him…

Panic Disorder is the most common of the anxiety classifications, marked by sudden feeling of terror/intense anxiety that strike repeatedly and without warning. Often, the sufferer fears s/he will die. Physical symptoms include chest pain, heart palpitations, shortness of breath, dizziness, and abdominal discomfort. Approximately one-third of patients admitted to hospital emergency rooms for chest pains are actually having a panic attack. Panic disorder may often be mistaken for medical problems such as hyperthyroidism or cardiovascular disease. Sometimes dizziness and rapid breathing may also be mistaken for neurological problems like a brain tumor.

Panic disorder may also include an associated condition known as agoraphobia, or a fear of open spaces. Agoraphobics are generally afraid a being trapped in a public place, thus they may be reluctant to drive, take a bus or ride the subway, go to the grocery store, etc. for fear they’ll be unable to escape should a panic attack strike. In extreme cases, suffers of this combination become housebound.

Obsessive-Compulsive Disorder (OCD)

A bright child can’t complete school assignments because she checks and re-checks her answers repeatedly…

Those suffering from OCD typically experience repeated, intrusive thoughts or obsessions they find disturbing and are unable to control. Many sufferers perform some ritual(s) [i.e. hand washing, repeated checking to see if doors are locked or stoves are off, repeating of words & phrases, etc.], to help relieve their anxiety, but usually they find only temporary relief. Most OCD sufferers realize their worries are exaggerated, but can’t stop them.

Post-Traumatic Stress Disorder (PTSD)

Symptoms of PTSD may emerge after an individual has undergone or witnessed a traumatic event or circumstance outside the normal range of human experience [i.e. war, child abuse (sexual/physical), disasters (earthquake, flooding, airplane/auto crash, etc.). Although symptoms may appear within days or weeks of the trauma (acute), it is not altogether uncommon for the symptoms to emerge many months or even year later (delayed). Symptoms of PTSD include: nightmares, flashbacks, numbing of emotions (dissociation), anger and irritability, distraction, and a tendency to be easily startled. PTSD is an example of an anxiety condition where depressive features may be a significant aspect of the affliction. Sufferers of PTSD often withdraw from family and friends in an effort to avoid situations that might prompt or trigger memories of trauma.

Phobias

Phobias are extreme, disabling and irrational fears of things that aren’t actually dangerous. As a result of fear, people limit their lives as they avoid certain objects and social situations. Common phobias include: intense fear of flying, closed spaces, height, blood, spiders, snakes, etc. Social Phobia is the fear of being judged by others or of displaying public behavior that could lead to embarrassment. It can ruin careers and prevent intelligent children from doing well in school.

Generalized Anxiety Disorder

Individuals suffering from Generalized Anxiety Disorder typically experience exaggerated worry about everyday routine life events and activities. They almost always anticipate the worst. Sufferers often report primarily physical symptoms including: fatigue, trembling, muscle tension, headache, and nausea. Furthermore, many sufferers of this affliction devote so much attention to worrying they develop memory problems. Because this condition lacks dramatic symptoms of other anxiety disorders, it can be sometimes difficult to diagnosis accurately.

Treatments

Anxiety disorders in general may be difficult to diagnosis accurately. Consequently, it is recommended that treatment of anxiety disorders (or any other psychiatric condition for that matter) begin first with a physical exam to rule out any medical problems which may be the cause or be contributing to the presenting symptoms. As the predominate trend thusfar has emphasized that these conditions are biologically rooted, it should not be surprising that the initial primary treatment approach has centered heavily on medications. While there is no denying the effectiveness of drug therapies for these conditions, the disadvantages of relying solely on medications include a limited emphasis to symptoms with little or no acknowledgment of environmental or underlying psychosocial dynamics; and potential risk to drug dependency (addiction) and/or subsequent prescription abuse.

Psychotherapy combined with medications is generally considered the most effective strategy in providing people with the best opportunity to resolve or manage anxiety disorders. Suggested therapy approaches are briefly described below:

Behavioral Therapy is a common approach in addressing anxiety conditions. Clinicians using these methods help individuals gradually face what they fear by showing how to gain control over they anxiety. Sometime referred to as Exposure Therapy or Systematic Desensitization, some therapists even accompanies the client into real life situations that cause fear.

Cognitive Therapy is another approach commonly employed in addressing anxiety conditions. The aim of this method is to assist individuals to change the way they think about fear. Therapists help clients to distinguish between their thoughts and their feelings and separate realistic thoughts from unrealistic ones.

While these two common psychotherapies may be effective individually, their effectiveness may be further enhanced in combination and/or in conjunction with medications. In general, these approaches work well together, often resulting in short-term treatments. Additional approaches which may also be included within psychotherapy interventions include:

Relaxation Techniques help many people who suffer from anxiety afflictions. Progressive muscle relaxation for example involves the systematic tensing and relaxing of muscle groups.

Family Therapy may prove especially beneficial as significant others in treatment can significantly hasten recovery. As anxiety disorders tend to run in families (and sometimes rule them), a family approach can provide additional sources of information about a client’s environment and major factors within it.

Hypnosis can easily be employed in individual therapy, group and family therapy, behavior therapy and cognative therapies. Hypnosis has long been recognized as a tool used to control and/or better manage anxiety. In Behavior and Cognitive tehrapies, hypnosis has been used to enhance relaxation, generate imagery, heighten the expectation of success, and change self-defeating thoughts. Additionally, it has been used to facilitate covert reinforcement, in which the client imagines a reward after imagining the desired action, and desensitization, in which relaxation and imagery are used to eliminate phobias. The use of hypnosis is also recognized in reducing the discomfort and anxiety produced by any uncomfortable medical procedure, especially in children. Finally, hypnosis has been used in the treatment of PTSD since the first World War and remained a popular and effective approach ever since.

Sufferers of anxiety afflictions need not feel “it’s just in your head”. It is more likely that what your experiencing is real and treatable.

References

Levenson, D. “Anxiety: It’s Not Just `All In Your Head’”, NASW News, February 1997, Vol. 42, No.2 (p.3).

“Hypnosis”, The Harvard Mental Health Letter, April 1991, Vol. 7, No. 10 (p. 3-4).