Anxiety Disorders and Their Treatment
I've had to deal with fairly high
anxiety all of my life. So this is going to be a little more of a
personal page.
On top of this, Mustang Sally is my high anxiety horse. I just figured
out the other day, she is, in fact, a metaphor for this in my life and dealing with it. You can read more about her and one of our adventures by clicking here.
In my work with teens and adults with various related disorders, I must admit mine is at the low end of "high". Plus, at this age of my life, I have learned to deal with it for the most part. I meditate, exercise, work around the farm, and work with the horses. All of which help me deal with stress.
Mine takes primarily the form of worry: I'm a real worrier. Not so much as I used to, but still there. I get it naturally. Both of my parents are pretty high anxiety/worriers.
Admittedly, mine does not fall into the clinical or psychopathological category, but it is nonetheless very bothersome and unpleasant at times. At one point in some really high stress times, it verged on a real panic attack.
OK, so enough about me. How is your anxiety? Or are you reading this for your child, teen, spouse, a friend, etc.? Is the issue one of the several of its related disorders? Stress? Worry? PTSD? OCD? A phobia? Social phobia? Etc, etc, etc. If so, read on...
First we will address some general characteristics about anxiety. Then, we will discuss briefly the various anxiety related disorders. Finally, we will talk about treatment and some helpful ways you can deal more effectively with it.
General Characteristics of Anxiety
While the DSMIV, our "Bible" of psychological disorders, does not list general characteristics of anxiety, here are the most important. These are generally given for generalized anxiety disorder...
- Excessive worry
- Restlessness or being keyed
- Difficulty concentrating or mind going blank
- Irritability
- Muscle tension
- Sleep disturbance
Psychobiology of anxiety
We have dedicated a separate webpage to discuss the psychobiology of anxiety, including some of the underlying genetics and evolutionary aspects... click here
Types of Anxiety Disorders
Here are briefs description of several of the anxiety related disorders:
Panic Attacks
In panic attacks there are brief, but very intense, periods of fear or discomfort that can include several of the following symptoms:
- Pounding heart, palpitations, or accelerated heart rate
- sweating
- trembling or shaking
- shortness of breath or smothering feelings
- feelings of choking
- chest pain
- nausea
- dizziness, unsteady, lightheadedness, faint
- feelings of derealization or depersonalization
- fear of losing control or going crazy
- fear of dying
Agoraphobia
This is about feelings of anxiety about being in a place or situation which is difficult to escape or that help may not be available. Situations are avoided or marked with great distress.
Technically, agoraphobia is a fear of open places. So many agoraphobics will stay inside as much as possible and dislike going outside.
Phobias
Used to be referred to as simple phobias, these are fear of specific objects or situations. These fears are irrational and exposure to the object or situation produce intense anxiety.
Can include flying, heights, spiders or other animals, receiving an injection, seeing blood, storms, thunder, lightning, water, and others.
Social phobia
A subtype of phobias, this is a fear of social or performance situations. This seems to have become much more common in our culture for some reason. Unfamiliar situations or people can evoke as well.
Generalized Anxiety
Excessive worry or anxiety about a number of events or activities such as work or school with the anxiety symptoms listed above.
Acute Stress
When someone is exposed to a traumatic event in which 1) they experienced or witnessed or were confronted with actual or threatened death, serious injury to self or others. And 2) their response involved intense fear, helplessness, or horror.
After the experience the person may show one or several of the following symptoms:
- a sense of numbing, detachment, or absence of emotional response
- reduced awareness of surroundings
- derealization
- depersonalization
- dissociative amnesia about the trauma or event
The trauma or event is persistently reexperienced in terms of images, thoughts, dreams, illusions, flashbacks, or reliving the experience. There is a marked avoidance of things that arouse memories of the trauma and marked symptoms of anxiety and increased arousal. These disturbances last from 2 days to a maximum of 4 weeks and occur within four weeks of the trauma.
Post Traumatic Stress Disorder (PTSD)
Much like the acute distress disorder described above, except that it lasts longer, i.e. for more than a month.
Obsessive-Compulsive Disorder (OCD)
Obsessions are defined as
- recurrent and persistent thoughts, impulses, or images that are intrusive and inappropriate and that cause marked anxiety or distress
- these are not just excessive worry about real life situations or problems
- the person attempts to suppress or ignore these with some other thoughts or actions
- s/he recognizes these obsessions are a creation of his or her mind
Compulsions are defined as
- repetitive behaviors (e.g. hand washing, checking locks, ordering) or mental acts (e.g. praying, counting, repeating words silently) that the person feels driven to perform in response to an obsession or rigid rules
- these are directed toward preventing or reducing distress or preventing some dreaded event. However, these acts are not connected in a realistic way to neutralize or prevent or are clearly excessive
Treating and Living with Anxiety
I am not going to go into a discussion of meds except to say that excessive anxiety and its related disorders can sometimes be managed by antidepressants (SRRI's see under Depression). Rather, I want to focus on cognitive-behavioral approaches. I might add that I use a type of cognitive-behavioral hypnotherapy to help many clients work with their anxiety and related disorders.
As mentioned at the start of this webpage, I employ a combination of exercise, meditation, and relaxation techniques to manage my own anxiety. Oh, I might add prayers to this list also. Lots of prayers. I work with animals and horses around the farm. I am not sure whether to count these as relaxation techniques or exercise. They are usually a little (or lots) of both. Here are some short takes on these various approaches:
Exercise
Exercise has been demonstrated to increase brain growth (neurogenesis), but also reduce stress. I used to jog. As I became older, I decided I liked walking better. (I know some 70 year olds plus that still job by the way.) I get in a lot of work around the farm in terms of cutting and splitting firewood (we heat 80% by firewood), hauling hay and feed, gardening, fencing, and repair and maintenance. And, let's not forget the horses. I find doing both ground work or saddle work (a.k.a. riding) can involve a lot of exercise.
Meditation
Meditation has been throughly demonstrated to be great stress/anxiety reducer. In "meditation" here I include not only mindfulness and Buddhist meditation, centering prayer (Christian), Transendental meditation, etc., but also Tai Chi, Yoga, and other moving meditations. (I have a booklet I am trying to find the file for that explains zazen, Zen Buddhist meditation. Look for it on my Blog.)
A great resource for this as well as the Yoga is Jon Kabat-Zinn's, Full
Catastrophe Living: Using the Wisdom of Your Body and Mind to Face
Stress, Pain, and Illness
Relaxation Techniques
I used to ride Harley's as a relaxation technique (see WindWalker
page) and, of course exercise and meditation are relaxation techniques
too. H. Benson's, The
Relaxation Response
I will be publishing shortly two techniques I routinely use with my clients. The first is a relaxation hypnotherapy/guided meditation. The second is my own version of the Body Scan, featured in Kabat-Zinn's book above also. Again, these will be announced on my Blog.
Index to Teen Problems and Issues:
- Attachment and RAD
- Asperger's
- Non-verbal Learning Disability
- Depression
- Bi-Polar
- Cyclothymia
- Dysthymia
- ADHD
- LD
- Conduct Disorder
- Oppositional Defiance
- Anger
- Drugs and addiction
- Abuse
- Children of Divorce
- Parent-Teen Relationship
- Problems Sibling
- Relationship Problems