By Simone Sobel, LCSW
19th Nervous Breakdown seems not just the witty title of a 1966 Rolling Stones song, but also an apt characterization of how anxiety provoking it can feel to navigate life in 2015. In this series of blog posts, I will explore how therapists commonly define, assess, and treat anxiety. I will describe various types of anxiety (such as generalized anxiety, phobias and panic attacks), causes (such as family-of-origin, biological/medical, or life change stressors), and also describe some of the most effective techniques for managing uncomfortable symptoms (such as desensitization, altering distorted beliefs or working on anxious traits within our personality).
Bill is a mid-level executive at a large Fortune 500 Company. He is hard-working, well-regarded, and a solid performer. At home he is an involved father who attends his kids’ baseball games, school plays and PTA conferences together with his wife. Bill is also a volunteer treasurer at his neighborhood property association and a regular church goer. He used to play basketball on weekends with some guys from his church, but hasn’t had time for that in the last few months, with his packed schedule, even on weekends. Lately Bill has been having a hard time dealing with a controlling boss, whom he feels micromanages his every move and has been critical of Bills work in staff meetings. Bill is also doing his best to juggle his work schedule with his wife’s schedule, so they can share responsibility for taking one of their children, who has recently developed a serious gastrointestinal issue, to doctor appointments. In the last few weeks Bill has been feeling lightheaded and dizzy at work and has been having trouble sleeping. One day Bill begins to feel chest pains, lightheadedness, dizziness and a tingling sensation in his arm. He goes downstairs to the minute clinic in his office building and, after describing his symptoms, the paramedics are called. Bill is hooked up to an EKG machine and in the midst of being screened for a heart attack, he passes out. He comes to a couple of minutes later and is rushed to hospital, while one of his colleagues calls Bill’s wife. Bill remains in hospital overnight, where he is given blood tests, another EKG, a chest X-ray and an MRI. As the test results come back, all negative, the ER doctors can find no evidence of heart attack, stroke or any other medical condition. They conclude that Bill has suffered a panic attack and send him home with a prescription for Xanax.
Bill’s panic attack experience is all too common. According to the National Alliance on Mental Illness (NAMI), 1 in 20 Americans will be diagnosed and treated for Panic Disorder each year. The good news is that panic and anxiety are usually very responsive to treatment. Anxiety is often defined as a vague, unspecified sense that one is in danger, losing control or that something bad is going to happen in the near or distant future. While anxiety is a normal human response that we may feel it in situations of stress, newness, danger or difficulty, it can become problematic when it starts to escalate in frequency and intensity, when it doesn’t dissipate even long after a particular stressful or fearful event or period in our lives eases, and when it seriously affects our ability to function. Psychologist Edmund Bourne notes that anxiety can affect us on multiple levels simultaneously: physically, we may sweat, have rapid heartbeat or feel tension in our muscles among other physiological reactions; behaviorally we may avoid certain places or activities or feel unable to function properly in daily life, such as being unable to make a presentation at work or meet new people; psychologically we may feel a constant sense of tension, stress and nervousness or feel that we are going crazy or that something is irrevocably defective about us and our ability to cope in our lives.
Types of Anxiety Disorders
There are many different types of anxiety disorder, which the DSM V (the classification system therapists use to assess mental health disorders) groups into various diagnostic categories, but here are the ones I see most frequently with clients:
Generalized Anxiety Disorder (GAD) often described as a pervasive and intense sense of worry and apprehension that can seem out of proportion to the likelihood that the feared event or situation will occur; usually accompanied by ongoing worry and a vague sense of impending danger
Panic Attacks are sudden episodes of intense anxiety that seem to appear “out of the blue.” They’re usually accompanied by uncomfortable physical sensations like difficulty breathing, heart palpitations, or chest pain, that can make you feel as though you’re having a heart attack or are going crazy or otherwise losing control.
Agoraphobia causes a person to avoid places or situations that may trigger a panic attack such as grocery stores, restaurants, buses, or being alone at home
Social Phobia is an intense fear of being embarrassed, humiliated, judged or scrutinized in social or performance situations, such as public speaking. Sometimes individuals will avoid social situations altogether in order to avoid experiencing high levels of anxiety.
Specific Phobias involve intense fear and avoidance of specific items or situations that can disrupt a person’s daily life, work or relationships. Exposure to the feared object typically causes great distress, even when the sufferer recognizes the fear as irrational. Common phobias include animals, heights, airplanes, doctors or dentists, blood or medical procedures, and elevators.
OCD occurs when activities of cleaning, tidying, checking, counting or ordering consume a person’s life for many hours in a day, significantly affecting the ability to function in other ways beyond the rituals. OCD includes two components: 1.) the obsession, which is an overpowering, intrusive thought that a person feels unable to stop and 2.) the compulsion, which is the behavior the individual engages in to relieve the anxiety created by the obsession. One example is spending hours washing one’s hands to reduce anxiety about being contaminated by germs.
PTSD is a series of severe psychological symptoms that occur following a traumatic event such as military combat, a natural disaster, a car accident or a violent assault, that induces intense fear, terror, horror, or hopelessness. Symptoms typically include intrusive thoughts about the event, nightmares, flashbacks, emotional numbness, insomnia, and loss of pleasure in activities once enjoyed, among other symptoms.
While, as mentioned above, anxiety is highly treatable, treatment can really vary depending on the specific issues. For example, panic attacks generally respond well to a combination of relaxation training, lifestyle changes, cognitive therapy and a technique called interoceptive desensitization (deliberately inducing symptoms of panic, such as rapid heartbeat through physical activity, to normalize the bodily sensations associated with panic.) With OCD, on the other hand, a therapist may find that cognitive therapy is not as effective in controlling symptoms as medications, such as SSRIs (like Prozac and Zoloft.) A client suffering from social phobia often benefits from social skills training or therapy focused on increasing self-esteem and assertiveness skills. With specific phobia, such as fear of flying, a therapist might help a client work incrementally through a list of feared associations, people, places or activities surrounding the phobia both mentally and in real life, gradually reducing the debilitating hold the fear has on the client.
Many people struggle with more than one type of anxiety—panic attacks with agoraphobia, for instance. It’s important to rule out medical conditions that may be causing anxiety, such as thyroid disease, or possible side effects of medications, substance use or stimulants such as caffeine and nicotine. Sometimes anxiety-like symptoms may be masking a different mental health issue, such as depression. All of this means that it is vital to have a very thorough assessment with a trained mental health clinician as the first step in any type of therapy for anxiety.