Stomach acid, racing heart, and you lay there worrying about something that you fear will happen in the future. Perhaps you keep saying “What if………”, to yourself about a number of possible negative situations.
The word “anxiety” is derived from the Latin word “anxietas”, which means agitated distress. There are some medical illnesses that can cause a person to suffer from undue distress. Just a few of these physical causes are: the fluctuating female hormones, thyroid disease, and adrenal gland dysfunctions. Caffeine from coffee, soda, and tea is one of the most common causes of anxiety.
Everyone, believe it or not, experiences anxiety. Just as a smoke detector warns of impending fire, anxiety acts as our alarm warning us of impending danger. This is called the flight or flight response. It is at this moment that the higher brain sends out a danger message to the limbic system, which then sends out a chemical message through the pituitary gland or by way of the sympathetic nervous system. This is when your heart begins to beat quickly, your blood pressure increases, respiration changes, and your body is ready to take action to help you survive.
This is both normal and adaptive, but two basic problems can occur:
1. the biological mechanism can malfunction so that it is sensitive and sends out the “flight or fight” signal in situations that are only minor stressors, or
2. out of the blue it becomes activated for no apparent reason.
2. out of the blue it becomes activated for no apparent reason.
These reactions occur because the higher brain areas perceive danger when no danger exists, and it sends danger messages to the limbic system at inappropriate times.
GAD or Generalized Anxiety Disorder is characterized by chronic anxiety that causes: feelings of shakiness, muscle aches, shortness of breath, gastrointestinal disturbances, dry mouth, feeling keyed up, and feeling “on edge”. But the hallmark of GAD is excessive worrying or “what ‘if-ing’”. In most of the cases I see, clients suffering from GAD experience difficulty concentrating and falling asleep because their minds won’t turn off. Most cases of GAD can be treated successfully with psychotherapy along with relaxation exercises, meditation, imagery, visualization, and positive self-talk. In some cases where the disorder has significantly impaired the individual, medication along with psychotherapy may be in order.
Panic Disorder affects 3 to 5% of the population. Panic disorder is a chemical dysfunction that occurs in certain areas of the brain. Clients who I see (both men & women) experience tremendous emotional suffering, yet panic disorder is very treatable. These panic attacks start out as an intense anxiety reaction, & some are so intense that a person often ends up in a hospital emergency ward. (A major portion of the clients I see who suffer from panic disorder have been referred to me by E.R. physicians). After a few of these attacks some people begin to worry about when the next attack will occur, to the extent that they remain on guard for future attacks. This is what is known as anticipatory anxiety.
Some people develop phobias. A phobia is a specific fear. The most common phobias are the fear of heights, airplanes, & snakes. People with phobias are strongly motivated to avoid that fear. This starts out for example, let’s say when a person is driving a car or flying in a plane, & they have a panic attack. They then become afraid of driving a car or flying in an airplane, because they associate those activities with having a panic attack. These attacks are tremendously frightening, & some people will go to great lengths to avoid experiencing another one. Often this avoidance goes to the extent of not leaving their homes. With their lives now being so restricted, depression &/or marital conflicts often occur.
Prolonged, untreated panic disorder can result in substance abuse. It is understandable that people can turn to alcohol to ease the anxiety, but unfortunately alcohol intensifies panic in the long run.
The treatment of choice for panic disorder is medication. Anxiolytic (anti anxiety drugs), SSRI’s (antidepressant drugs), & sometimes a combination of the above is needed. Medication, when used properly, can be quite effective. Once the intensity of the anxiety is decreased through medication, the next step is to reduce anticipatory anxiety & deal with the phobias.
Once the anxiety has waned, you need to expose yourself to things you’ve come to fear. I stress this because if you don’t move to this point, your fears will run your life. For example, if you’ve grown afraid to go out to the grocery store, it is important that you gradually face the feared situation. It is helpful to do this in small steps. What I recommend to my clients is to spend some time in the parking lot of the grocery store & then return home.
The next trip you get out of your car & walk to the entrance of the store. The next day you walk into the entrance & stand there for a couple of minutes, & the next trip you can walk around inside the store; etc., etc., until you are able to do your grocery shopping. The most effective amount of time for exposure therapy, as research has shown, is 60 minutes.
The anxiolytic medicine alone cannot stop phobias. They are effective in reducing anxiety, but only exposure to the feared object or situation will cure the phobia. Physical exercise helps to decrease the symptoms of anxiety; however in panic disorder, exercise can actually exacerbate the symptoms.
Because I provide insight therapy, the cause of a client’s anxiety is what we explore together. The presence of anxiety is symptomatic of internal psychological conflicts of which the client is unaware.
Post Traumatic Stress Disorder is usually the result of a person’s being exposed to very severe, sometimes life-threatening situations such as child abuse, rape, war, car accidents, etc. Those suffering from PTSD often experience intrusive, repetitive thoughts, also known as flashbacks. Nightmares are also a common symptom. The more severe cases of PTSD present as people who experience dissociative symptoms which are an array of unusual feelings such as derealization where the world suddenly feels odd or unreal. Depersonalization is another, where the person doesn’t feel real, & feels a sort of numbness & mental confusion. The treatment for PTSD is medication & psychotherapy.
- Obsessive Compulsive Disorder is characterized by thoughts a person can’t avoid thinking, or a behavior a person can’t avoid doing. Constant checking & rechecking is indicative of OCD. Hoarding & controlling are common symptoms as well. Do you remember the movie As Good As It Gets with Jack Nicholson? His character was a classic obsessive compulsive personality. The primary function of rumination & rituals is the regulation of anxiety. SSRI’s & psychotherapy are the preferred treatment.
The pathway to freedom from fear begins with learning to live in the present. Fear is paralyzing, & many of the clients I see are paralyzed by it because fear keeps you stuck in a narrow range of behaviors, thoughts, & feelings. Whenever you step out of your comfort zone, fear abruptly steps in your path, & stepping out of your comfort zone activates your hidden fears.
“Fear is created not by the world around us, but in the mind, by what we think is going to happen.” Elizabeth Gawain