The Ball and Chain of Anxiety

Anxiety (and even fear) can be helpful.  It can motivate us, keep us focused, alert, and increase our performance in tasks.  If, however, the anxiety doesn’t go away after the situation, increases significantly in intensity, or just remains “hanging” like a cloud all the time, the consequences can be harmful.  They can considerably affect your everyday functioning or even affect your physical health with problems such as cardiac symptoms, reduced immunity, Gastro-Intestinal symptoms, excessive fatigue, and many of the other stress related physical symptoms.  According to the National Institute of Mental Health (NIMH), approximately 18% of all U.S. adults have an anxiety disorder.

Symptoms of Potentially Harmful Anxiety

  • Excessive worry about everyday things, even if there is little or no reason to worry about them
  • Unable or having extreme difficulty controlling the constant worrying.
  • Knowing that the worry is excessive.
  • General inability to relax
  • Concentration difficulties
  • Startled easily and has trouble falling asleep or staying asleep.
  • Fatigues easily
  • Headaches
  • Muscle tension and aches
  • Difficulty swallowing
  • Trembling, shaking, or twitching
  • Irritability
  • Sweating
  • Nausea
  • Lightheadedness
  • Racing heart
  • Chest pain or discomfort
  • Shortness of breath
  • Excessively going to the bathroom
  • Hot flashes

Types of Anxiety Disorders

The following are common anxiety disorders that include many of the above symptoms as well as their own indicators

  • Panic disorder
  • Obsessive-compulsive disorder
  • Post-traumatic stress disorder
  • Phobias
  • Generalized anxiety disorder

Adapted from URL: http://www.nimh.nih.gov/health/publications/generalized-anxiety-disorder/index.shtml#Generalized-Anxiety-Disorder by Dr. Derek T. Schwartz Ph.D, BCIAC on 11/11/09.

IMPORTANT NOTE: Having some of these symptoms may not immediately indicate an anxiety disorder.  Please consult your physician and/or other health care provider for an evaluation as many of these symptoms could be related to an underlying medical condition.

What Leads to Anxiety?

DNA

Like depression, some types of anxiety disorders (such as Generalized Anxiety Disorder) tend to run in families and may have a genetic component to them. Many people might have a roller coaster of anxiety all their lives while others may start getting an increase in anxiety symptoms times during middle age.  Much about the genetic component of anxiety is still currently under research.

Brain Chemistry

Again, as with depression, an imbalance of brain chemistry may be responsible for symptoms of an anxiety disorder. One focus of treatment may be to use medication to correct neurotransmitter levels in the brain to reduce symptoms of anxiety.

Environment and Psychological Factors

It is well established that anxiety can be exacerbated by increased levels of stress.  Once again, like depression, events such as trauma, loss of a loved one, a difficult relationship, occupational stress, and other stressors can elevate anxiety levels.

Treatment of Anxiety

Medication

Anti-Anxiety medications can be very effective with treating symptoms such as “in-the-moment” worry and feeling “on edge”, helping with panic attacks, etc.  Many, such as Xanax®, are used “as needed” to reduce these symptoms when they occur.

Psychotherapy and Counseling

Because medications may not resolve all the symptoms of anxiety, provide any coping techniques or anxiety reduction methods, or address potential underlying causes of the anxiety, working with a mental health provider trained in anxiety reduction can be very valuable.

Psychotherapy and Counseling

Common Psychological Therapies

Behavioral Therapy

Focuses on using techniques and concepts designed to reduce or even stop behaviors that are associated with creating or exacerbating anxiety.  This can include relaxation techniques (with or without Biofeedback) to (1) counteract anxious symptoms such as shortness of breath and (2) retrain your physiology to naturally reduce system tension (e.g., breathing more regularly and more deeply on a regular basis).

Cognitive Therapy

Explores the role of thoughts involved in anxiety and focuses on patients’ understanding of how their thoughts contribute to the symptoms of anxiety.  Many of these anxious thoughts (like with depression) may be unrealistic views of the world or of their lives which may be responsible for adding or even creating anxiety symptoms.  These are called Cognitive Distortions. Patients learn how to recognize these thoughts and methods to change thought patterns to reduce symptoms of anxiety. This increased cognitive awareness is often combined with behavioral techniques to help individuals gradually (1) confront and overcome the potential “thought” origins of their anxiety and (2) tolerate and reduce anxiety provoking situations as well as anxious symptoms in their everyday lives.  This combination of “challenging” distorted or “maladaptive” thinking and encouraging (or discouraging) certain behaviors to reduce symptoms is commonly called Cognitive-Behavioral Therapy (CBT).

Systematic Desensitization (Graduated Exposure Therapy)

A treatment process in which individuals with feared situations or specific phobias are first taught relaxation and stress reduction skills and then subjected to a series graded exposures to the situation or fear.  For example, if someone is afraid of spiders, he or she will first learn techniques to lower anxiety generally and around spiders specifically.  Then the person is given a picture of a spider and has to lower the anxious reaction to the photo using his or her techniques.  Later, the person may be shown a video of the spider or even more spiders.  Over several sessions of increasing exposure to spider oriented material, the person will be able to hold a spider in his/her hand without a strong anxious reaction.  The goal for the individual is to learn to cope, tolerate, and overcome the fear and anxiety in each step of this hierarchy, thus reducing the sensitivity to the situation and ultimately conquer the fear after successfully coping with all the exposures.

Other common psychotherapeutic treatments include Interpersonal Therapy and Psychodynamic Therapy.  In addition, stress many play a role in anxiety, thus stress management tools and approaches may also be helpful (See “Stress Management: Maintaining Balance” Section)

Nutrition

There is data showing that certain foods can potentially increase or decrease symptoms of anxiety.  For example, not surprisingly, Caffeine has the ability to increase symptoms of anxiety while taking certain B vitamins can potentially reduce anxiety.  [Please contact your primary care physician, local dietitian or nutritionist, and/or pharmacist for further information]

Sleep

In the research, there is a lot of data correlating lack of sleep and an increase in anxiety. However, sometimes it’s a “chicken or the egg” situation.  Was it the lack of sleep that led to the anxiety or the other way around?  Either way, there’s a strong connection between the two and working on improving your sleep is very important.

Stress Reduction

Make changes in your life to help manage and reduce stress. As with depression, excessive stress is likely to (1) increase symptoms of anxiety which (2) may lead to a cyclical pattern of extended “overhanging” long-term level of anxiety.

Supplements

There are certain supplements such as Valerian and Passion Flower (or combining them) that may have some research support to reduce symptoms of anxiety.  Be VERY careful, however, when using supplements, make sure your physician or psychiatrist is aware of exactly what you are taking.  They may have interactions with other medications you are taking or may harm your body in some other way.

Adapted from URL: http://www.nimh.nih.gov/health/publications/depression-easy-to-read/index.shtml#When-the-Blues-Don&apost-Go-Away by Dr. Derek T. Schwartz, Ph.D, BCIAC on 11/09/09

Taking the Angst Out of Anxiety with Dr. Schwartz

“You don’t have to be the rabbit in Alice in Wonderland”

Anxiety Can Make Me Think

  • I always feels like “I’m late for a very important date”…but there isn’t one.
  • My heart is jumping out of my chest!
  • I’m having a heart attack
  • Is this ever going to stop.
  • I have too much on my plate…it’s just too overwhelming
  • If I have to go to the bathroom one more time!…
  • I just can’t sleep, it’s driving me crazy…my brain just won’t shut off
  • I wish I could hide under a rock with all these people around me.
  • I swear, this upcoming exam is making me jump out of my skin
  • I don’t know why I’m on edge all the time…I just can’t figure it out
  • Sometimes I just can’t even think of going outside
  • Geez…another Xanax for this flight

Anxiety Can Make Me Feel

  • Irritated
  • Ashamed
  • Indecisive
  • Worried
  • Discouraged
  • Shy
  • Uneasy/Unsure
  • Tense
  • Distressed
  • Desperate
  • Paralyzed
  • Frustrated
  • Tormented
  • Preoccupied
  • Scared/Frightened
  • Panicked
  • Alarmed
  • Nervous
  • Restless
  • Timid
  • Nervous
  • Anguished

Anxiety Can Make Me

  • Stay at home
  • Unnecessarily perform poorly on tasks
  • Avoid people or other situations
  • Overly check everything I do
  • Not take chances with things I know I need to do.
  • Not get into relationships that I want or mess up the ones I have
  • Communicate poorly
  • Hide from the world!
  • Become overwhelmed

So What to Do???

Just like depression, anxiety can be a big factor in our lives and can affect the decisions we make, how people treat us, and how motivated we are in everyday life. Just with biofeedback alone, we can look at heart rate, sweating, muscle tension, skin temperature, and breathing on a computer screen to help determine how you body is reacting to anxiety.  Again, as with depression, combining the computer data and psychotherapy, counseling, and/or hypnotherapy, we can work to control physiology “on screen” with biofeedback, as well as explore how these affect us on an individual basis and how we can manage the thoughts, behaviors, and emotions that surround these conditions. Ultimately, we want to reduce the frequency, duration, and intensity of symptoms of anxiety to improve quality of life.

Ask:  “What can I do to challenge these anxious thoughts?  How can I overcome these frustrating feelings to do the things I want to do and the things I need to do?  How can I not let this terrible anxiety control my life?  “How can I get back into the world without feeling so on edge all the time?

Examples of Potential Goals with Dr. Schwartz

  • Get back my life back from anxiety; gain control.
  • Finding out where this anxiety comes from and how to get over the hurdles
  • Overall symptom reduction to function better in daily life
  • Anxiety reduction to improve relationships with both friends, romance, and family

Summary

Dr. Schwartz can help you explore, cope, and control symptoms of anxiety with the eventual goal of improving your daily functioning as well as improving your overall quality of life.