I’m a Licensed Professional Counselor, Author, and Teacher at a local university. My tagline is “help for hurting people.” Last week I sent out an email asking my subscribers what they wanted me to write more about. Two popular topics were grief and anxiety. So here’s a primer about anxiety. Please let me know what else you would like to know more about. You can read more about my areas of interest here. I am not providing clinical or professional counseling in this post. If you suffer from anxiety please consult a physician or trained clinician.
What Causes Anxiety?
Anxiety disorders may be caused by environmental factors, medical factors, genetics, brain chemistry, substance abuse, life experiences, personality, or a combination of these. It is most commonly triggered by the stress in our lives.
What are the Types of Anxiety Disorders?
Panic attack – A sudden wave of intense apprehension, fearfulness, or terror with physical symptoms such as shortness of breath, palpitations, sweating, and chest pains. Attacks often occur under stress or for not apparent reason.
Panic disorder – Recurrent panic attacks that occur suddenly and without warning, and a cause persistent and without warning, and cause persistent concern and interfere with social functioning.
Specific phobia – Substantial anxiety caused by exposure to a particular feared object or situation.
Social phobia – Substantial anxiety caused by certain social situations or performing in front fo a group, such as speaking in public.
Obsessive-compulsive disorder – Recurrent distressing thoughts (obsessions) and uncontrollable repetitive behaviors (rituals or compulsions) intended to reduce anxiety provoked by those thoughts. Symptoms last more than an hour a day and cause significant distress or interfere with normal functioning.
Acute stress disorder – Anxiety symptoms that last for up to a month following a traumatic experience.
Post-traumatic stress disorder – Distressing thoughts, anger, and other anxiety symptoms that occur for more than a month following a life-threatening or severe traumatic experience.
Generalized anxiety disorder – Excessive anxiety and worry about a variety of things on most days for at least six months. Physical symptoms, such as muscle tension, increased heart rate, and dizziness, may also occur.
Medical conditions that mimic or provoke anxiety symptoms – Pronounced anxiety, panic attacks, obsessions, or compulsions caused by a medical condition such as thyroid disease, treatment with steroids, or respiratory disease that causes difficulty breathing.
Substance-induced anxiety – Pronounced anxiety, panic attacks, obsessions, or compulsions caused by a medication, drug abuse, or exposure to a toxin. Examples included amphetamine or cocaine use.
(Source: Harvard Medical School Special Health Report)
How is Anxiety Diagnosed?
To help diagnose generalized anxiety disorder, your health provider may: Do a physical exam to look for signs that your anxiety might be linked to an underlying medical condition. Order blood or urine tests or other tests, if a medical condition is suspected.
If symptoms of an anxiety disorder are present, the doctor will begin an evaluation by asking you questions about your medical history and performing a physical exam. Although there are no lab tests to specifically diagnose anxiety disorders, the doctor may use various tests to look for other medical illness as the cause of the symptoms.
If no other medical illness is found, you may be referred to a psychiatrist, psychologist or another mental health professional who is specially trained to diagnose and treat mental illnesses. Psychiatrists and psychologists use specially designed interview and assessment tools to evaluate a person for an anxiety disorder.
The doctor bases his or her diagnosis on the patient’s report of the intensity and duration of symptoms — including any problems with daily functioning caused by the symptoms — and the doctor’s observation of the patient’s attitude and behavior. The doctor then determines if the patient’s symptoms and degree of dysfunction indicate a specific anxiety disorder.
Is Anxiety Linked to Depression?
Two-thirds of people with anxiety disorders also suffer from depression at some point in their lives, and 58% of people with depression also have an anxiety disorder. The anxiety/depression combination is so common that many mental health experts now consider it a distinct disorder. The presence of depression in patients with anxiety disorders increases the severity of both illnesses, the likelihood of alcohol or substance abuse, and the risk of suicide. It also reduces the chances that treatment will succeed, unless both disorders are fully treated. In other cases, people may have one of these disorder first, recover from it, and then develop the other. Anxiety can be a symptom of depressive disorders and depression can be a symptom of anxiety disorders.
How is Anxiety Treated?
Cognitive behavioral therapy (CBT) – CBT the leading form of therapy for anxiety. I like to think of CBT as attacking “stinkin thinkin.” CBT examines how negative thoughts, or cognitions, contribute to anxiety, and examines how you behave and react in situations that trigger anxiety. The basic premise of cognitive behavioral therapy is that our thoughts—not external events—affect the way we feel. In other words, it’s not the situation you’re in that determines how you feel, but your perception of the situation.
Exposure Therapy – Exposure therapy, as the name suggests, exposes you to the situations or objects you fear. The idea is that through repeated exposures, you’ll feel an increasing sense of control over the situation and your anxiety will diminish. The exposure is done in one of two ways: Your therapist may ask you to imagine the scary situation, or you may confront it in real life. Exposure therapy may be used alone, or it may be conducted as part of cognitive behavioral therapy.
Insight-oriented psychotherapy – This form of “talk” therapy delves into how life events, desires, and past and current relationships affect your feelings and contribute to your anxiety.
*Many counselors will use a combination of the counseling therapies listed above.
Medication – Anxiety used to be treated mainly with benzodiazapines (Valium, Ativan, Xanax), drugs that slow the central nervous system. The rationale was that slowing the nervous system would get overanxious people to relax. Doctors try to limit the use of benzodiazepines because they can cause tolerance—that is, a need for greater amounts of the drug to produce the same effects. In the s1970s and 1980s, it became clear that certain antidepressants were also effective in treating anxiety disorders. Some medications used for anxiety are Selective serotonin reuptake inhibitors (SSRIs), Venlafaxine (Effexor), Tricyclic antidepressants (TCAS), Monamine oxidase (MAO) inhibitors. TCAs are the older class of medications and tend to have more numerous and severe side effects than SSRIs; they are considered second-line treatments. People who take MAOs must avoid certain foods and beverages, including yogurt, aged cheese, pickles, beer or red wine, and other foods containing the amino acid tyramine. Other medications include buspirone, atypical antipsychotics, beta blockers, and non-benziodiazepines (Sonata, Ambien, Lunesta).
Alternative Approaches to Treating Anxiety
Mindfulness meditation – Focusing our attention on what is happening in the present, and accepting it without judgement. Mindfulness is often learned through meditation, a systematic method of regulating your attention by focusing on your breathing, a phrase, or an image.
Biofeedback – Biofeedback involves taking measure of specific body functions, such as a heartbeat or breathing, and feeding them back to an individual in the form of sounds or lights.
Relaxation techniques – Deep breathing, visualization, and body scanning. I like yoga because you strengthen and stretch as well as relax.
Eye Movement Desensitization and Reprocessing (EMDR) – Check out this video.
Exercise – Some research shows that physical activity can modestly reduce anxiety symptoms. Exercise also boosts self-esteem slightly and improves social interaction skills, both of which can help reduce anxiety. Exercise increases endorphins, natural chemicals that act like painkillers. Animal studies show exercise increases the level of brain-derived neurotropic factor (BDNF), a protein that is linked to anxiety and depression.
What other questions do you have about anxiety?
Lucille Zimmerman is a Licensed Professional Counselor with a private practice in Littleton, CO and an affiliate faculty teacher at Colorado Christian University.
She is also the author of Renewed: Finding Your Inner Happy in an Overwhelmed World. Through practical ideas and relatable anecdotes, readers can better understand their strengths and their passions—and address some of the underlying struggles or hurts that make them want to keep busy or minister to others to the detriment of themselves. Renewed can help nurture those areas of women’s lives to use them better for work, family, and service. It gives readers permission to examine where they spend their energy and time, and learn to set limits and listen to “that inner voice."