Anxiety

 Anxiety disorders affect about 25% of the general population at some time in their lives. People suffering from anxiety disorders spend twice the amount of money seeking non-psychological medical help compared to those without anxiety disorders. Counting both the direct cost of health services and lost productivity, the total annual cost generated by anxiety disorders in the US alone is estimated to be $45 billion dollars, 50% of this cost comes from excess, and mostly unnecessary, use of primary health care (e.g., medical ER visits).1

Individuals who suffer from Panic Disorder are the most frequent seekers of psychological services, and the most frequent psychological diagnosis seeking medical ER services.1 Panic attacks consist of a discrete period of intense fear or discomfort, in which four (or more) of the following symptoms develop abruptly and reach a peak within 10 min:

  • Palpitations, pounding heart, or accelerated heart rate
  • Sweating
  • Trembling or shaking
  • Sensations of shortness of breath or smothering
  • Feeling of choking
  • Chest pain or discomfort
  • Nausea or abdominal distress
  • Feeling dizzy, unsteady, lightheaded, or faint
  • Derealization (feelings of unreality) or depersonalization (being   detached from oneself)
  • Fear of losing control or “going crazy”
  • Fear of dying
  • Paresthesias (numbness or tingling sensations)
  • Chills or heat sensations

The attacks have been followed by a period of at least one month of worry about additional panic attacks, and/or a significant negative change in behavior such as avoidance of something like exercise, unfamiliar situations, or anything that is feared to provoke a new attack.2

Individuals diagnosed with Generalized Anxiety Disorder have a very increased risk of having an alcohol or drug abuse disorder (about 20%) at some point in their lives.3 This underscores the dire importance of getting effective treatment for this very debilitating group of disorders.

Symptoms of Generalized Anxiety Disorder include the following:

  • Excessive anxiety and worry most days for at least six months
  • The individual finds it difficult to control the worry

And the adult individual experiences three or more of the following symptoms (for children, only one symptom is necessary):

  • Restlessness or feeling on edge
  • Being easily fatigued
  • Difficulty concentrating or mind going blank
  • Irritability
  • Muscle tension
  • Sleep disturbance—trouble falling or staying asleep2 

Evaluation

Competent treatment has to begin with a thorough clinical interview designed to discover all the details and history of the complaints of symptoms, in this case of anxiety, which cause someone to seek professional help. This often requires two or three sessions, and always includes a review of one’s early life, family of origin, and the beginnings of the appearance of symptoms as well as their growth to the current time. In addition, it is sometimes useful to include psychological testing, which can be brief, and can involve standardized questionnaires. For individuals who are challenging to understand, testing can be lengthier, and involves more extensive personality evaluation techniques. 

Treatment

For more immediate short-term symptom relief, a cognitive behavioral therapy (CBT) approach can help a person face and overcome their anxiety difficulties, usually in the specific situations that trouble them most. This approach typically involves gathering very specific details about the situations that provoke the episodes of anxiety, and then tailoring mental and sometimes physical exercises to counter the effects of the symptoms.

In order to better understand the causes of the anxiety symptoms, and the functions, both positive and negative, that they serve in one’s life, a more thorough and detailed approach can be very helpful and can have more extensive and long-lasting benefits. This approach is usually described as psychodynamic or psychoanalytic, and aims not only to relieve immediate symptoms of anxiety, but also to teach patients how to engage in therapeutic analysis and reflection, when on their own and outside the therapy office. The philosophy of this approach is aptly reflected in the proverb, “Give someone a fish, feed them for a day. Teach someone to fish, feed them for a lifetime.”

When necessary, a referral to a physician can be considered for trials on medications for anxiety, which usually proves to be very helpful. In general, responsible medical practitioners prefer to prescribe medications which are not habit-forming, and have minimal side effects. Often, they recommend medications that belong to the family of SSRIs (Selective Serotonin Reuptake Inhibitors) a large and well-established group of medicines including the brand names Prozac, Zoloft, Paxil, Celexa, and Lexapro. They are approved for the treatment of a variety of conditions, including anxiety, depression, obsessive thinking and compulsive behaviors, and panic disorder. In addition, there are two more recent additions which are marketed as improvements to the SSRI familyVybriid, and Brintellix. These also target the brain chemical serotonin, but seek to balance it in an even more sophisticated way than in the past. Dr. Bonner collaborates with a number of experienced physicianschild and adult psychiatrists, neurologists, and primary care physiciansin effort to make these referrals as smooth and therapeutic as possible.

Contact Dr. Tom Bonner today to get expert help for ADHD.

 

REFERENCES (for further reading)

1Eifert, G. & Forsyth, J. (2005). Acceptance & Commitment Therapy for Anxiety Disorders. Oakland, CA: New Harbinger Publications.

2American Psychiatric Association (2013). Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition: DSM-5. Washington: American Psychiatric Association.

3Anxiety and Depression Association of America (2015). Substance Use Disorders. Retrieved from http://www.adaa.org/understanding-anxiety/related-illnesses/substance-abuse.