Anxiety is a very common and very human experience. So common in fact that all human beings experience some degree of anxiety. But there is a distinct difference between anxiety as a brief, understandable concern that occurs when thinking about the future (such as an exam, bills, or a life change) and the debilitating form of anxiety that affects day to day functioning and takes over your daily life. That’s when its likely to be an anxiety disorder.
Anxiety disorders are the most common reason why people seek help from mental health professionals. According to the Anxiety and Depression Association of America, around 40 million adults suffer from an anxiety disorder. That’s about 18% of the population! Yet many feel ashamed to admit to even having such symptoms. In one survey, only a third of people receivedtreatment for their anxiety disorder. This is unfortunate, because as a practicing psychiatrist, I can tell you that these disorders are treatable, which can transform the quality of your life. Let’s start with some definitions: Anxiety is an exaggerated fear of an anticipated threat to oneself. That can mean anything that you believe jeopardizes your existing life—your relationships, career, finances, etc. It can take the form of both thoughts and feelings. Both of these can affect your behavior or decisions in predictable ways. Oftentimes these predictable, but maladaptive coping behaviors reinforce anxiety. Avoidance and alcohol/substance use are typically the most common maladaptive coping behaviors. Thoughts can take the form of excessive worrying or overthinking and be hard to control. They are called ruminations. These can be intrusive, cause mental discomfort, and affect concentration or sleep. Ruminations also make a person irritable or experience anger outbursts. People who ruminate can become “stuck in their head.” By investing so much into the content of such repetitive worries they tend to avoid the very thing they fear. However, this only ends up making their anxiety worse. Those who experience anxiety describe it as: a sinking feeling in the pit of my stomach, a sense of dread or impending doom, butterflies in my stomach, feeling keyed up, or tension in the head or muscles. Sometimes these can lead to a rapid heartbeat, shortness of breath, tremors, dry mouth or sweating. If abrupt in onset, symptoms felt in the body can increase anxious thoughts, which could then be misinterpreted as a heart attack or feeling like you are about to pass out and die. This is called a panic attack. Having talked patients down from panic attacks, I can tell you that the most common reaction to one is usually rapid, shallow breathing (hyperventilating). This can make the panicky feelings even worse because it makes the person feel light headed, thereby leading to a cascade of worsening anxiety. Though not dangerous or fatal, panic attacks are the most dreaded of all anxiety symptoms. They typically lead to people escaping a situation, reaching for alcohol or drugs, or feeling paralyzed by their anxiety. There are various different types of anxiety disorders including: Generalized Anxiety Disorder, Social Anxiety Disorder, Panic Disorder and specific phobias such as a fear of flying or certain animals. Debilitating symptoms can be an aspect of mood disorders such as Major Depressive Disorder and Bipolar Disorder. People can have more than one type of anxiety disorder. Next, let’s talk about treatments. Both medications and therapy are crucial in treating anxiety disorders. When utilized together, it has been repeatedly proven that outcomes are much more positive.
Medications can be used as short-term and long-term treatment for anxiety disorders. Short-term treatments for anxiety can include medications like benzodiazepines. They can be very effective in reducing acute, severe (somatic) anxiety, including panic attacks. However, patients can become psychologically and physically dependent upon these medications if they are used over the course of months or years. This is because their effectiveness can wear off, as patients become tolerant to their therapeutic effect. Be aware that if you have been prescribed these for long periods, you may experience dangerous withdrawal symptoms if they are stopped abruptly and without medical supervision. Long-term treatments include some types of antidepressants and some mood-stabilizers. If taken consistently, and at the right dosage, they help to reduce the frequency and intensity of anxiety symptoms, allowing the person to benefit more from psychological treatments such as therapy. In my opinion therapy is underutilized compared to medication. This is partly because advertising by drug companies gives the impression that medications are instant miracle cures. It may also be due to the influence of stereotypes in pop culture that portray therapy as somehow outdated, unscientific or ineffective. Research has shown that nothing could be further from the truth. In fact, I strongly encourage my patients with anxiety disorders to regularly engage in therapy in order to properly educate themselves about their disorder and develop coping strategies. The most consistently proven effective therapy for the anxiety disorders is cognitive behavioral therapy, which breaks down anxious thoughts into various types of distorted thoughts. Some include black and white thinking, catastrophizing, and jumping to conclusions. These types of thoughts need to be challenged and replaced with healthier ones. Therapy can help you recognize your patterns and develop different strategies to manage anxiety. My own adage is: you are not your thinking. I also tell my patients: therapy is work. It requires active participation in your recovery. But it can also lead to lifelong rewards in freeing you from negative thinking patterns. While this is a basic summary of anxiety disorders, nothing is better than having a face to face conversation about anxiety with a trained mental health professional. This may be the most valuable decision you make as you embark on the rewarding journey towards resolving anxiety symptoms.
