Tag Archives: anxiety

Positive Dreams and a Peaceful Mind




Positive Dreams and a Peaceful Mind: Research Study

A new study conducted at the University of Turku (southwestern Finland) has found that our waking mind truly has an effect on our dreams. Sigmund Freud believed that dreams reveal the unconscious mind. It has long been believed that dreams can also reveal certain aspects of our conscious mind and daily thinking, feeling and over all well-being. Dream researchers in the past have focused more on the dreams of people experiencing various mental disorders rather than the positive aspects of dreaming and well-being. Do you have happier dreams if you are a happier person? Most researchers of well-being have focused on happiness and have neglected the important aspect of “peace of mind”.

Pillerin Sikka, Doctoral Candidate in Psychology at the University of Turku and Lecturer in Cognitive Neuroscience at the University of Skovde, and lead author in a recent article published in the Nature group Journal of Scientific Reports stated: “We wanted to address these important gaps in both dream and well-being research and to study how dream emotions are related to not only different aspects of waking ill-being, but also to different aspects of waking well-being, including peace of mind. In fact, this is the first study to look at how peace of mind relates to dream content.”




She went on to state, “Peace of mind is a state of inner peace and harmony, a more complex and durable state of well-being traditionally associated with happiness in the Eastern cultures”.

The study’s co-author Antti Revonsou, a Professor of Psychology at the University of Turku and Professor of Cognitive Neuroscience at the University of Skovde added that, “Even though it has rarely been directly measured in studies of well-being, in several philosophical traditions and spiritual approaches, peace of mind has always been regarded as central to human flourishing”.

Researchers in the study asked healthy individuals to fill out a questionnaire that measured their “ill-being” or “well-being” while awake and were then asked over the next three weeks to keep a daily dream diary which they would fill out each morning upon awakening detailing their dreams and rating the emotions experienced in those dreams. It was found that individuals experiencing higher levels of peace of mind experienced more positive dream emotions while those experiencing higher levels of anxiety also experienced higher levels of negative dream emotions.

These results concluded that if we are to understand how dreams are related to our waking state, we need to focus not only on symptoms of mental “ill-being” but also need to measure various aspects of “well-being”. Sikka explained that although some aspects of what we typically consider to be “well-being” did not seem to be related to dream content. There seemed to be something unique about “peace of mind”.

It has been proposed by researchers that one explanation for these conclusions is that possibly people who have higher levels of “peace of mind” may be better able to regulate their emotions not only when they are awake but also when they are dreaming. Obviously, the opposite would then be true for individuals with higher levels of anxiety.

Sikka concluded that the next step in research may be to find whether the ability to regulate emotions and maintain a higher-level of self-control is something that is fundamental to people with higher levels of “peace of mind” and whether improving these skills could actually lead to higher levels of peace of mind.

Adapted by Paul Susic Ph.D. Licensed Psychologist from article “Sweeter Dreams in a Peaceful Mind” ScienceDaily, August 24, 2018

Story Source:

Materials provided by University of Turku.

Journal Reference:

Pilleriin Sikka, Henri Pesonen, Antti Revonsuo. Peace of mind and anxiety in the waking state are related to the affective content of dreams. Scientific Reports, 2018; 8 (1) DOI: 10.1038/s41598-018-30721-1


Specific Phobia Disorder Treatment Information You Need to Know




Specific Phobia Disorder Treatment and Information: An Overview

Specific phobia disorder can be a very uncomfortable condition at the very least and absolutely disabling at its very worst. However, there are ways to cope with specific phobia disorder to prevent it from undermining an individual’s entire life. It is obviously imperative to have a good understanding of the condition as well as a recognition of when treatment is necessary. Specific phobia disorder involves a fear and avoidance of very specific circumstances or situations. It is very different from panic attacks and agoraphobia in various ways including that there are no spontaneous panic attacks or fear of panic attacks as you would experience in agoraphobia. It is also very different from social phobia in that there is no fear of embarrassment or humiliation in social situations. Direct exposure to the feared object can cause a panic reaction however. Often the fear and avoidance are significant enough to interfere with an individual’s daily functioning including working and social relationships, and frequently cause a tremendous feeling of distress. Frequently, individuals recognize the irrationality of their fear and response, but it continues to cause a considerable level of difficulty in their lives. Although there are many types of specific phobias some of the more common ones follow:

Dental or doctor phobias. Frequently these will begin with a fear of pain related to either dental or medical procedures conducted in the physician or dentist office. Later this may be generalized to anything related to or in memory of doctors or dentists. Unfortunately, this fear may cause some people to not seek medical or dental services when necessary.




Airplane phobia. Usually this phobic disorder is related to a fear of an airplane crashing. Often fears of the cabin depressurizing and not being able to breathe are part of the imagined scenario. A more contemporary version of this phobia is a fear of hijacking or a bombing of the plane Many individuals with this phobia will have an actual panic attack while flying. Some experts have concluded that approximately 10% of the population in the United States will not fly at all while an additional 20% will fly but experience tremendous anxiety.

Illness phobia. This phobic reaction is in relation to a fear of getting a specific medical condition such as cancer or having a heart attack. People with an illness phobia tend to seek constant reassurance from doctors and medical personnel and will avoid any reminder of the dreaded disease if possible. Illness phobia is also very different from hypochondriasis in that with a specific illness phobia people tend to focus on one specific illness as opposed to imagining the development of a variety of diseases or medical conditions.

Elevator phobia. This phobic reaction is usually in relation to fears of elevator cables breaking and the elevator crashing to the floor or being stopped and trapped inside. This fear frequently can cause an individual to have a panic attack although they have not previously had any history of panic disorder.

Animal phobias. The fear associated with this phobia is usually in relation to a variety of animals including rats, spiders, snakes, bats, dogs, and various other animals. This phobic disorder frequently begins in childhood where often the initial fears are considered to be rational or normal. It is only when they continue into adulthood and begin to undermine or interfere with an individual’s daily functioning that they actually develop to the point of becoming a specific phobia disorder.

Acrophobia. This phobia is often referred to as a “fear of heights”. Acrophobia can be related to a multitude of circumstances such as fear of being on the upper floors of a tall building, on top of a mountain, or even bridges. Individuals who experience this type of specific phobia disorder often say that they experience (1) dizziness or vertigo for (2) a feeling of being drawn toward the edge or an urge to jump.

Thunder and/or lightning phobias. This phobic disorder almost always starts in childhood. It is when it actually persists beyond the adolescent years that it is then defined as a specific phobia.
Specific phobias are very common and are believed to affect approximately 10% of the population. Because they do not always result in severe impairment in daily functioning, a significant amount of people who experience these fears and avoidant reactions do not seek treatment. Specific phobias seem to occur equally between men and women. Animal phobias however seem to be more common among women and illness phobia seems to be more common among men.

Development of Specific Phobia Disorder:

Specific phobias in general are usually fears about specific objects and circumstances experienced in childhood that were never really outgrown. However, in some circumstances they can be fears that are developed following the experience of a traumatic event such as an accident, illness or violent experience. Unfortunately, another precipitating factor which may lead to the possible development of a specific phobia may be the modeling of others. For example, repeated exposure to a parent who has a specific phobia can result in children developing it also.

Specific Phobia Disorder Treatment:

Specific phobia disorder treatment can be different from the usual treatment of panic disorders in that specific phobias do not generally involve spontaneous panic attacks. Therefore, they don’t often include treatments such as panic control therapy, interoceptive desensitization and medication.

Cognitive therapy. One of the more common treatments for specific phobia includes cognitive therapy which helps to recognize, challenge and replace some of the specific thoughts that perpetuate the fearful reactions and avoidance behavior. Fearful thoughts such as “What if I panic when I’m trapped on an airplane?” Can be replaced with thoughts such as “Although I’m on the plane for two hours, I will be off soon.”, or “I can get my mind on something else like reading or watching a movie.” These coping statements are usually rehearsed until they are internalized and often are accompanied with deep breathing or relaxation techniques.

Incremental exposure. This type of specific phobia treatment involves exposing the individual to the feared object or experience in incremental steps. An example of this may be when a fear of flying is incrementally approached through the use of imaginary flying experiences such as looking at pictures of people flying or even watching planes take off and land. Also, an individual may take a very short flight at first rather than a longer one. Initially they may even have a support person to accompany this individual, and eventually they may then take the flight on their own.

Relaxation training. Deep breathing and muscle relaxation can be practiced on a regular basis to reduce the general level of experienced anxiety. Relaxation training can be used to help with anticipatory anxiety as well as deep breathing while actually confronting the specific object or circumstance.

Some phobic objects and circumstances are not amenable to real-life desensitization such as earthquakes or other natural disasters. In these circumstances cognitive therapy would be used along with exposure to imaginary experiences of these natural disasters such as looking at pictures or watching movies associated with these feared catastrophes.

Specific phobia disorder conclusion:

It is always important to understand that specific phobia disorder is relatively benign initially, especially if it begins as a childhood fear. Although it has been found at times to last for many years and even decades, it will usually not get worse and sometimes will diminish over time. Fortunately, this disorder is not usually associated with other psychiatric disorders or mental health problems. People with specific phobia disorder often function at a high level in other aspects of their lives.

By Paul Susic Ph.D. Licensed Psychologist




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Agoraphobia Symptoms and Treatments: Must know Information




Agoraphobia Symptoms and Treatment Overview:

The symptoms of agoraphobia may be the most prevalent of all of the anxiety disorders with as many as 5% of the general population or one in 20 people experiencing varying degrees of agoraphobic symptoms. In the United States, the only mental health disorder that experiences a higher level of prevalence may be alcoholism. Therefore, an understanding of agoraphobia symptoms, diagnosis and treatment is imperative to a well rounded understanding of panic and mental health disorders.

Agoraphobia symptoms:

From a practical perspective, agoraphobia is experienced as a fear of having panic attacks although the term actually refers to a fear of open spaces. An individual experiencing agoraphobia usually has an intense fear of having a panic attack and being in a circumstance in which escape is impossible. An individual may avoid such things as driving on highways for fear of having a panic attack, and being unable to escape the circumstances. Most people experiencing agoraphobia symptoms fear not only the panic attack , but being observed by others while having panic symptoms. Some of the more common circumstances avoided by agoraphobics are:

• Being trapped home alone.
• Being in areas where they feel enclosed such as while getting an MRI, tunnels etc.
• Being on public transportation and unable to leave if necessary such as on a bus or train.
• Being in places such as grocery stores or restaurants and other crowded places.

Agoraphobics frequently feel comforted when a “safe person” is present, which seems to help alleviate the agoraphobia symptoms. One of the more common features of this panic related disorder is a fear of being away from home and/or away from this “safe person”. A “safe person” may be a spouse, parent or anyone whom you have a significant relationship with who provides some comfort in these anxiety provoking situations. You may have an intense fear of driving or walking alone or experiencing any other circumstance without this “safe person”.




Most people who are agoraphobic have a relatively high level of anxiety most of the time. Much of this anxiety seems to be anticipatory, fearing future circumstances and situations which may provoke a panic attack, such as a fear of being left alone at home in the future. The severe restrictions on your life related to future panic attacks may also result in depression. Some people experience depression when they are in adverse circumstances that they have no control over which seem unescapable.

Agoraphobia Symptoms and Panic Disorder:

Agoraphobia develops as a result of having panic attacks or panic disorder. At the very beginning you may have panic attacks that occur for no reason, eventually resulting in a panic disorder. Later you begin to recognize that these panic attacks are occurring in specific situations and you begin to avoid those circumstances for fear of having continued panic attacks. These panic symptoms may be mild at the beginning resulting in uncomfortable feelings but not necessarily avoiding these specific circumstances. When experienced at a more moderate level the panic symptoms begin to result in avoidance of these panic inducing circumstances such as avoiding public transportation or shopping on your own. In these moderate anxiety circumstances, you may avoid some panic inducing situations but still continue on without serious restrictions on other aspects of your life. The restriction is usually only partial. When experiencing severe agoraphobic symptoms, you may experience restrictions which seem to affect every aspect of your life, resulting in being unable to leave home unaccompanied.

It is not really known why some people develop agoraphobia from their panic attacks and why others do not, or why agoraphobia is more severe for some rather than others. Some clinicians and researchers believe that the development of agoraphobia may have some environmental and hereditary components. It has been observed to run in families and twin studies have found that identical twins have a higher risk for both to develop agoraphobia. When looking at environmental factors, there may be some childhood experiences that predispose a child to agoraphobia. Some of these experiences may include growing up with parents who (1) are overprotective and/or (2) are overly anxious and communicate that the world is a “dangerous place” and/or (3) overly critical and perfectionistic.

People experience agoraphobia symptoms from all walks of life and all socioeconomic levels, At the present time, approximately 80% of agoraphobics are women. It is unclear what environmental issues factor into the gender difference, although it has been noticed recently that the level of agoraphobic women relative to men with the disorder seems to be leveling off somewhat. That would probably indicate more of a environmental than a genetic influence.

Agoraphobia Symptoms and Treatment:

There are various treatments available to help alleviate the symptoms of agoraphobia. Since agoraphobia is basically a disorder developed in relation to panic disorder and panic attacks, the same treatments are utilized for both including psychosocial treatments and the management of panic attack symptoms utilizing anxiety medications and antidepressant medications. An overall analysis of the medication management of panic disorder and panic attacks as well as an overview of the psychosocial treatments of panic disorder follow on separate pages.

Some of the main psychosocial treatments include relaxation training, panic control therapy and interoceptive desensitization. Once again, the same treatments that are utilized for panic disorder and panic attacks are also used for patients with agoraphobia. Also, additional assistance or treatment for agoraphobia symptoms may also include assertiveness training since agoraphobics frequently have difficulty standing up for themselves. Finally, as mentioned previously, some of the main treatments for agoraphobia include medication, graded exposure, cognitive therapy and group therapy.

Agoraphobia Treatments with Medication:

Some of the main treatments for agoraphobia as well as panic attacks and panic disorder include treatment with medication such as selective serotonin reuptake inhibitors (SSRI’s) such as, Zoloft and Paxil and tranquilizers such as Xanax, Ativan or Klonopin. The SSRI’s are more likely to be used in very severe cases where a person is homebound and otherwise very restricted in their activities of daily living. Low doses of tranquilizers such as Xanax may also be used to assist people who are going through the early stages of exposure treatment as well as being used by many doctors as a mainline treatment for anxiety and panic.

Graded exposure treatment for Agoraphobia:

When the treatment or intervention is referred to as “exposure” therapy it usually means that the person is exposed to the stimuli that seems to provoke the anxiety or panic reaction. Situations or circumstances that have been feared and/or avoided are exposed to the individual in incremental steps to gradually increase the amount of time and exposure without having a full-blown panic attack. A good example of graded exposure may be if a person has a severe fear of driving long distances or on the highway. They may initially drive short distances or at slower speeds and build up to greater distances or greater speeds. Sometimes a support person is used to accompany the agoraphobic. Finally, they may then eventually be able to drive alone. If a person is fearful of staying home alone, they may be at home by themselves for short periods of time building up to longer times alone.

Cognitive Treatment to Alleviate Agoraphobia Symptoms:

The goal of cognitive therapy is to help the individual recognize and eliminate exaggerated, fearful thinking which result in phobias and panic attacks in a more realistic way. You will then learn to identify, challenge and ultimately replace counterproductive thoughts with ones that are more helpful and realistic to the stimuli or environment.

Group therapy:

Agoraphobia symptoms can be effectively treated in a group setting with other individuals experiencing similar symptoms and disorders. Group therapy provides an opportunity for an individual to share their experiences with others and recognize that they are not alone and that there are many others who experience agoraphobic related panic attacks.

Agoraphobia Symptoms and Treatment: Some Final Words

Agoraphobia symptoms are successfully treated through the use of several psychosocial interventions and medications to alleviate the symptoms. Additional information is also available on this website related to panic disorder, psychosocial interventions and medication management. Do not allow yourself to continue to suffer agoraphobia symptoms when treatment is so readily available.

Some information adapted by Paul Susic Ph.D. Licensed Psychologist from The Anxiety and Phobia Workbook by Edmund J. Bourne Ph.D.



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Panic Disorder Treatment: The Best Long-term Solution




Panic Disorder Treatment: An Overview

The treatment of panic disorder is usually approached very differently from the way it probably should be in that the first line of treatment is almost always to “throw a medication at it”. When given the fact that the medications usually used for panic disorder treatment have serious side effects, a more reasonable approach would probably be to consider possible psychological interventions prior to using medications that have serious side effects. These medications may be necessary in place of psychological interventions or in addition to, but they should not always be the first line of defense in the treatment of panic disorder. In fact, efficacy studies related to the treatment of panic disorder with cognitive behavioral therapy, have found that it performs as well as pharmacological interventions in the short-term and may possibly be more durable in the long-term.

Panic Disorder Treatment: The Psychological Approach

The core feature in the treatment of panic disorder from a psychological treatment perspective, is that panic disorder is frequently caused by and maintained by heightened fears associated with anxiety symptoms. The main psychological treatment modality in current practice by psychologists and other mental health practitioners is cognitive behavioral therapy (CBT) which seeks to reduce those fears. The belief which has also been confirmed by research is that it is this “fear of fear” that is the main culprit and the focus of intervention. This fear can be reduced, resulting in the clinical improvement of panic disorder. Cognitive behavioral therapists utilize various cognitive techniques including psychoeducation about panic along with cognitive restructuring, as well as behavioral methods such as interoceptive exposure to assist in the reduction of the symptoms of panic disorder.




Psychoeducation for Panic Disorder:

Psychotherapists using the cognitive behavioral method, usually first begin by providing patients with information about panic disorder. Information and education about panic and how it is maintained is seen as the most basic aspect of this program, allowing the patient and therapist to collaborate on future treatment and intervention. It has been found that there is an enormous amount of misinformation about panic symptoms as well as how they will affect the individual patient. Many patients present to emergency rooms mistaking intercoastal muscle tension in the chest as an indication that they are having a heart attack. Cardiac arrest is much more than pain in the chest. It most often involves a crushing pain in the chest usually accompanied by pain shooting downward through the arm. Also, many patients mistake hyperventilation-related dizzy feelings for fainting, without realizing that ultimately dizziness may be the result of blood pressure and the heart rate suddenly dropping. In actuality, an elevated heart rate during panic will actually protect against fainting in spite of dizziness.

There are certain physiological reactions that protect us from various threats including what has been referred to as the “fight or flight” reaction to stress or danger. The “fight or flight” syndrome is actually believed to help protect us against danger but is not in itself threatening or dangerous. It is a heightened level of physiological arousal that allows us to respond to threatening or dangerous circumstances, but does not specifically pose a threat to our well-being.

Some patients also fear that the physiological symptoms of panic disorder will lead them to more serious mental health concerns. These additional mental health worries also exacerbate the underlying mistaken beliefs that bodily sensations and a fearful response to dizziness and heart palpitations for example, will lead to a full-blown panic attack or result in some other type of mental illness.

Panic Disorder Treatment and Basic Beliefs:

Cognitive behavioral therapy focuses on catastrophic beliefs and misconceptions about our bodily sensations and the prevention of testing these misconceptions and refuting these beliefs. In order to assist with alleviating these catastrophizing beliefs, the therapist may ask the patient what has kept them from experiencing the actual catastrophe that they had envisioned. In most circumstances, patients will indicate that they have taken various safety measures to short-circuit the catastrophe from actually occurring. For example, a patient may state that they are afraid that the panic disorder related dizziness will result in them becoming weak and falling down. The therapist may then ask what has kept them from falling down in the past? The patient will usually state that they were able to sit down prior to falling down. They were able to rely upon these safety measures to keep the catastrophe from actually occurring. So, in effect, specific catastrophic thinking can be addressed along with safety measures that maintain the related fears that seem to drive the panic process.

Panic Disorder Treatment: Using Cognitive Restructuring

Another important aspect of panic disorder treatment using the cognitive behavioral approach involves using the cognitive restructuring of catastrophic beliefs. An important part of cognitive restructuring of these beliefs is that behavioral experiments are also used along with psychoeducation to alleviate the panic symptoms. The behavioral experiments are used to provide direct, experimental evidence that catastrophic consequences are not the inevitable result of catastrophic thoughts and the experience of heightened physiological sensations. A behavioral experiment may involve something as simple as when an individual believes that they will faint when dizzy and immediately sits down to avoid falling down. The behavioral experiment might involve having the patient hyperventilate while sitting down and experiencing the related sensations of dizziness and lightheadedness. The patient’s catastrophic thinking might involve the thought that they will faint if they stand up. The therapist may then encourage the alternative prediction that only a slight sense of unsteadiness will actually occur. Having the patient experience the physical sensations without having them engage in the customary safety behavior is one of the most powerful ways to help an individual change the catastrophic thinking that maintains the panic disorder. The goal of the therapist is to have the patient experience behavioral experiments that allow them to refute the beliefs associated with the usual bodily symptoms. Cognitive restructuring is actually a combination of psychoeducation and the creation of behavioral experiments that allow the individual to refute the catastrophic beliefs.

Panic Disorder Treatment: Exposure

Panic disorder is experienced pretty much in the same way that individuals experience phobias. After an individual experiences a high level of anxiety in relation to a certain stimuli they may then attempt to avoid similar experiences. Prolonged exposure to stimuli that is feared causing an extinction of the fear is an important feature of the behavioral treatments associated with anxiety and panic disorders. In individuals with panic disorder, the principle of exposure requires people to expose themselves to the stimuli that they fear and feel the related bodily sensations until they no longer hold the same capacity to provoke fear and discomfort.

Deep Breathing and Additional Treatments for panic disorder:

Some additional panic disorder treatments include applied muscle relaxation and breathing retraining, which is oriented toward counteracting hyperventilation. However, some therapists now wonder if these techniques are such a good idea. These methods were originally designed to help reduce the intensity of the bodily sensations which by implication were bad, which is contrary to the psychoeducational component in which these sensations are essentially taught to be considered harmless. However, teaching the concept that anxiety management techniques are a means of helping an individual to feel some sense of control over their bodies may indeed have some value.

Panic Disorder Treatment and Agoraphobia:

An intense fear of certain circumstances and objects can cause patients to avoid those experiences. This residual agoraphobia can continue even after panic has been successfully treated using cognitive behavioral techniques. Psychologists and mental health clinicians will frequently develop in vivo (real-life) exposure situations where individuals will purposefully enter into feared experiences and circumstances without avoiding the stimuli until the intense discomfort is reduced or goes away.

Some final words on panic disorder treatment:

There have been many studies over time that have identified the efficacy of psychological approaches to the management of panic disorder. Cognitive behavioral therapy delivered on an individual basis or in a group setting has been found to significantly reduce symptoms of panic. Some studies have found as many as 74 4% of cognitive behavioral therapy treated patients are panic free posttreatment. Similar outcomes have also occurred in community mental health settings. Also, cognitive behavioral therapy has significantly outperformed other interventions including the use of some medications such as imipramine, applied relaxation and emotion focused therapy. Finally, panic disorder treatment using psychological methods including cognitive behavioral therapy with or without medication have frequently been found to be the best long-term solution to the treatment of panic disorder.

Some information adapted by Paul Susic Ph.D. Licensed Psychologist from Practitioner’s Guide to Evidenced-Based Psychotherapy by Jane E. Fisher and William T. O’Donohue




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Panic Disorder Medications: Side Effects, Pros and Cons






Panic Disorder Medications: An Overview

Researchers and clinicians have found that the most effective panic disorder medications include the tricyclic antidepressants (see depression medications: tricyclic), monoamine oxidase inhibitors (see depression medications: MAOI’s), benzodiazepines (see anxiety medications), and the selective serotonin reuptake inhibitors (see depression medications: SSRI’s). These medications all have similar effects on panic disorder, although some doctors conclude that the SSRI’s tend to be a little more effective over the long-term. These medications do differ in relation to their side effects and also their contraindications, which are other medications and food that they may interact poorly with. Some have anticholinergic effects which include such side effects as dry mouth and blurred vision, which seem to be more common with the tricyclic antidepressants. These medications are also contraindicated for people with comorbid cardiac disorders. There are also significant dietary restrictions when using the MAOI’s in which you may be asked to abstain from any foods containing tyramine. The benzodiazepines may cause sedation and impairment in motor coordination as well as have some addictive qualities and a tendency to develop a tolerance to the medications. Obviously, panic disorder medications include several choices but also include a variety of side effects and negative interactions with other medications and foods and require careful consideration by both patients and doctors.





Panic Disorder Medications: Are the SSRI’s really the best choice?

Many doctors have concluded that when looking at both the efficacy and side effects, selective serotonin reuptake inhibitors (SSRI’s) may be the most promising choice for panic attacks and panic disorder. But like all medications, SSRI’s have side effects also that may make them unappealing, such as you may feel a short-term increase in arousal-related sensations. To assist with this however, SSRI’s may be started at a very low dosage (for e.g. 12.5 mg/d for sertraline; 5-10 mg./d for paroxetine) and then gradually increased (up to 25-200 mg/d for sertraline and up to 10-50 mg/d for paroxetine). The choice of a specific SSRI is based upon a variety of factors including personal preference and an individual’s history of response or nonresponse, and the related side effect profile.

What other medications are used in the treatment of panic disorder?

For some individuals who do not respond to SSRI’s or for any other reason, a combination of medications may be used for the treatment of panic disorder. One example may be when SSRI’s are combined with benzodiazepines. The benzodiazepines in this situation may be used to lessen the side effects of the SSRI’s. Despite some preliminary positive effects, this strategy has not been used often and may need to be more properly evaluated. Another alternative strategy may be to simply change the individual’s medication. The newer non-SSRI antidepressants may be considered such as gabapentin, bupropion, nefazodone or venlafaxine. The problem with using some of these newer medications is that there’s not as much clinical experience and research data to back up the use of the strategy. Some clinicians use benzodiazepines for panic disorder and panic attacks.

Panic Disorder and Use of Benzodiazepines:

Some of the primary drugs that have historically been marketed to treat anxiety and panic disorders have been the benzodiazepines. The name benzodiazepine is derived from its chemical structure. This medication changes the way the body handles chemical messengers in the brain. It connects to receptors in the brain that monitor your awareness level, coordination, memory, muscle tone and suppresses the electrochemical transmission of nerve impulses in the brain. The benzodiazepines are very serious medications that are capable of producing anything from mild to very serious sedation of the central nervous system. Sometimes they are referred to as “sedative hypnotics” in that they cause sedation and sometimes may cause the user to feel like even while they are awake, that their routine communication almost has the feel of being somewhat of a “hypnotic command.”

Another problem with benzodiazepines is that psychological and physical dependence can become a real concern for the future, as there is risk of dependence even after a relatively short period of use at their most common dosage levels. That is why these medications are considered to be controlled substances and are dispensed only in limited amounts, ideally for a short duration of time. Stopping these medications suddenly can cause serious withdrawal symptoms due to the feeling of dependency. Tolerance to these medications also is known to occur requiring increased amounts to get the same therapeutic benefit.

Panic Disorder Medications: A Summary

As should be fairly obvious, the use of a specific medication for the treatment of panic attacks and panic disorders, requires significant clinical judgment by a physician well aware of the benefits and side effects of each specific medication. At the present time, antidepressants (especially the SSRI’s) seem to be eclipsing somewhat the use of benzodiazepines for the long-term treatment of panic disorder and generalized anxiety disorder. Another approach to treatment of the drug refractory individual is to use a psychosocial treatment such as cognitive behavioral therapy as an adjunctive or alternative treatment to panic disorder medications.

Some information adapted by Paul Susic Ph.D. Licensed Psychologist from DSM/IV/TR Mental Disorders: Diagnosis, Etiology and Treatment by Michael B. First and Allen Tasman and the No-Nonsense Guide to Psychiatric Drugs by Moira Dolan



The Causes of Anxiety Disorders: You Just Never Know




Cause of Anxiety Disorders: Introduction

Anxiety disorders can present themselves in many ways and have many different causes. They can be mild or severe, general or specific to certain circumstances and they can have one or many different causative factors. They may be somewhat understandable or may be absolutely irrational.

When considering the causes of anxiety disorders there are a couple of things to keep in mind. The first is that although you may understand the cause of an anxiety disorder it may not be absolutely necessary in order to learn to cope with or diminish it. Many of the techniques used to deal with anxiety disorders such as relaxation, exercise, changing self-talk and mistaken beliefs and so forth do not really depend on understanding the underlying cause of the anxiety disorder. The second important factor is that frequently there is not one certain cause, there could be several or even many operating on several different levels. These different levels could include hereditary factors, biology, family background, experiences and even beliefs.

“Single Cause” Theories of Anxiety Disorders:

There are some experts in the field of mental health who see anxiety disorders as developing from a single cause. Often, this perspective is not very helpful in working with anxiety disorders as they may come from various biological and psychological considerations. This oversimplification may result in two different mistaken lines of reasoning referred to as the biological fallacy and the psychological fallacy. The biological fallacy refers to the usually mistaken belief that the anxiety disorder is caused specifically by an underlying biological or physiological imbalance in the brain or body or a specific dysfunction in a certain part of the brain. Frequently, we will hear advertisements and even individuals refer to their depression or anxiety disorder as a chemical imbalance. This is usually an oversimplification that fails to recognize the dynamic interplay between our brains and the environment that surrounds us.




The Biological Fallacy:

It obviously is helpful to know the physiological components involved in anxiety disorders, but it is not helpful to ignore the potential complexity of the disorder. You may ask yourself, “What caused the physiological disturbance?” It is a known fact that chronic stress and psychological conflict may cause the locus ceruleus to malfunction in panic disorder, for example. Also, it has been identified that chronically suppressed anger may change the serotonin (neurotransmitter or brain messenger) levels in the brain contributing to obsessive-compulsive disorder. Both of these causative factors may be more related to the environment and the way an individual is raised rather than any specific inherited physiological or biological factors. To say that these are just chemical imbalances is very much an oversimplification and really not very helpful in the treatment of anxiety disorders.

The Psychological Fallacy:

The psychological fallacy of the cause of anxiety disorder can be equally as mistaken as the biological fallacy. To say that a specific anxiety disorder such as generalized anxiety disorder or social phobia are as a result of being neglected or abused as a child, or related to any other negative childhood experiences may be very misplaced and even destructive to individuals and families. In order to consider that the environment has contributed to the manifestation of an anxiety disorder doesn’t mean that it’s necessary to exclude biological factors such as inherited characteristics and other physiological considerations.

Cause of Anxiety Disorders – Summary of the Psychological Fallacy and Biological Fallacy:

in summary, the idea that the cause of anxiety disorders is either strictly psychological or strictly biological neglects the whole interactive aspect of “nature versus nurture”. We interact with the environment and as a result the brain and body chemistry change. The physiological aspects can include vulnerability to anxiety disorders but to say which came first may be impossible to know. Consequently, a comprehensive approach to treatment from anxiety disorders may include a multidimensional approach as opposed to treating specific factors in isolation. An effective treatment approach may include a consideration of biological, behavioral, mental, interpersonal, and even spiritual factors for lasting, meaningful treatment to take place.

Cause of anxiety disorders – Additional considerations:

In addition to the physiological and psychological aspects, some additional considerations include the time period over which anxiety disorders develop and are maintained. There are some factors which are considered to be predisposing factors, which may be inherited or experienced early in childhood making you more vulnerable to anxiety disorders. Others may be maintaining causes or triggering causes which are factors that continue the anxiety disorders going forward into your life.

In the Anxiety and Phobia Workbook Third Edition, Edward J. Bourne, Ph.D. has provided a list of the causes of anxiety disorders:

Causes of Anxiety Disorders:

I. Long-Term, Predisposing Causes

A. Heredity

B. Childhood Circumstances
1. Your parents communicate an overly cautious view of the world.
2. Your parents are overly critical and set excessively high standards.
3. Emotional insecurity and dependence.
4. Your parents suppress your self- assertiveness.

C. Cumulative Stress Over Time

II. Biological Causes

A. Physiology of Panic

B. Panic Attacks and the Noradrenergic Hypothesis

C. Generalized Anxiety and the GABA/Benzodiazepine Hypothesis

D. Obsessive-Compulsive Disorder and the Serotonin Hypothesis

E. Medical Conditions That Can Cause Panic Attacks or Anxiety

III. Short-Term Triggering Causes

A. Stressors That Precipitate Panic Attacks
1. Significant Personal Loss
2. Significant Life Change
3. Stimulants and Recreational Drugs

B. Conditioning and the Origin of Phobias

C. Trauma, Simple Phobias, and Post-Traumatic Stress Disorder

IV. Maintaining Causes

A. Avoidance of Phobic Situations

B. Anxious Self-Talk

C. Mistaken Beliefs

D. Withheld Feelings

E. Lack of Assertiveness

F. Lack of Self-Nurturing Skills

G. Muscle Tension

H. Stimulants and Other Dietary Factors

I. High-Stress Lifestyle

J. Lack of Meaning or Sense of Purpose

Cause of anxiety disorders: Conclusion

While the above list of the “Cause of Anxiety Disorders” is comprehensive it is not exhaustive of all the factors that may be considered when doing a diagnosis and trying to determine effective treatment of a specific anxiety disorder for a specific individual.

Some information adapted from the Anxiety and Phobia Workbook Third Edition, Edward J. Bourne, Ph.D. by Paul Susic Ph.D. Licensed Psychologist (Health and Geriatric Psychologist).




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Buspar for anxiety relief ?





Generic name: Buspirone Hydrochloride

Brand Name: Buspar

Buspar is referred to as a minor tranquilizer and has become very popular in providing relief from anxiety. Buspar is most often used to treat anxiety disorders, but is also prescribed at times for the aches, pains, fatigue, and cramps of premenstrual symptom (PMS). However, this and other anxiety medications are not usually prescribed for treating the anxiety or tension caused by the stress of everyday life.

Buspar: Basic General Information

Buspar or buspirone hydrochloride is a potent anti-anxiety medication that has become increasingly popular since its approval by the FDA for the relief of anxiety. It was approved by the Food and Drug Administration (FDA) for the short-term treatment of anxiety, but it has been used safely for more than four weeks at a time, as contrasted to several of the other popular anxiety drugs. It is not actually known how Buspar works at the present time, but has become very popular due to the lack of addiction and some of the other dangerous side effects frequently associated with other anti-anxiety medications, such as the benzodiazepines. It is believed to work by decreasing the amount and actions of the neurotransmitter serotonin in certain parts of the brain. It is not believed to depress the nervous system nor act as an anticonvulsant or muscle relaxant, as some of the other anti-anxiety medicines do. Minor improvement will frequently be apparent after about 7 – 10 days of starting treatment with Buspar, but its maximum effect usually does not occur for approximately three to four weeks. This medication is only available by doctor’s prescription in an oral form (tablets) in both Canada and the United States.

What are some of the special precautions and warnings?

You should not take Buspar if you have ever had any history of an allergic reaction or sensitivity to this drug. It should be used with caution by people with kidney or liver disease. It does not have any antipsychotic effects and should never be taken when experiencing symptoms of psychosis. Although it is not believed to have much potential for abuse, you should always be aware of this possibility. If you believe you will be using Buspar for a prolonged period of time, your physician should check your progress at regular visits to make sure the medicine does not cause unwanted side effects.




Other Considerations When Taking Busbar

When taking this or similar anti-anxiety medicines, you obviously will need to weigh the risk against the good it may possibly do. This is a decision you and your doctor will need to make. Before starting Buspar, the following factors should be considered:

Allergies and Reactions:

You should tell your doctor if you have ever had any unusual or allergic reactions to Buspar. You should also tell your doctor or nurse if you have ever had an allergic reaction to any other substances such as foods, preservatives or dyes.

Pregnancy:

This medicine has not been studied for use with pregnant women. However, this drug has not been shown to cause birth defects or other similar problems in animal studies.

Breast-feeding:

It has not been determined whether Busbar passes into the breast milk of humans.

Children:

Studies of this medication have been done only in adult patients, and it has not been determined whether it should be used in children under the age of 18.

Older adults:

This anxiety medication has only been tested in a limited number of older adults and has not been shown to cause side effects any different than those experienced by younger adults.

Other Medicines:

In some cases, certain drugs should never be used with other medications, while in other cases, two medicines may be taken together although an interaction might occur. In these cases, your physician may want to change the dosage, or take other precautions as necessary. If you are taking Buspar, it is very important that your doctor or nurse know if you’re taking any of the following medications:

• Erythromycin
• Itraconazole (e.g. Sporanox) -higher blood levels of Buspar may occur, increase the chance of side effects. Your physician may want to change the dosage of this anti-anxiety medication.
• Monoamine Oxidase Inhibitors (MAOI’s) (Marplan, Nardil, Parnate) taking Buspar when your taking monoamine oxidase (MAO) inhibitors may cause high blood pressure.

Other medical Concerns:

The presence of other medical issues may affect the use of Buspar. Make sure you tell your doctor if you have any of the following medical problems:

• Kidney disease
• Liver disease-Buspar may be removed from your body more slowly, which may increase the risk of side effects. Your doctor may need to adjust your dosage.

What are some of the Buspar side effects?

The side effects of Buspar cannot really be anticipated, but if any should occur or increase in intensity you should notify your doctor immediately. If you anticipate taking this anti-anxiety medicine for a long period of time, your physician will need to monitor its effectiveness as well as for its side effects. Buspar can make some people feel dizzy, lightheaded, drowsy or less alert than they normally feel. You should always make sure you know how you react to this medication before driving, operating machinery or any other activities that require concentration and being alert. Below are some of the major busbar side effects.

Along with the wanted effects, this medicine will cause some related side effects. Although not all of these Buspar side effects may occur, if they do, you should seek medical attention immediately.

Rare Buspar Side Effects:

Chest pain; confusion; fast or pounding heartbeat; fever; lack of coordination; mental depression; muscle weakness; numbness, tingling, pain, weakness in hands or feet; skin rash or hives; stiffness of arms or legs; sore throat; uncontrolled movements of the body.

There are other Buspar side effects which may occur that usually do not require medical attention. They may go away during your treatment as your body adjusts to the medicine. However, you should check with your doctor if any of the side effects continue or become bothersome.

Common Buspar Side Effects:

Lightheadedness and dizziness, especially when getting up from a sitting or lying position; headache; nausea; restlessness or excitement

Less Common or Rare Side Effects:

Blurred vision; sweating; decreased concentration; diarrhea; drowsiness (more common with doses of more than 20 mg. per day); dryness of the mouth; muscle pain, spasms, cramps or stiffness; ringing in the ears; trouble sleeping, nightmares, or vivid dreams; unusual tiredness or weakness.

There are some other Buspar side effects not listed above which may also occur in some individuals, however, if you notice any unwanted effects you should check with your physician immediately.

Buspar Dosage: What is the proper amount?

Your dosage of Buspar should be taken as directed by your doctor. You should never take more than your physician recommends. Also, you should never take it for a longer period of time than your physician has prescribed. Doing so may increase the risk of unwanted side effects.

After you begin taking buspar (buspirone), you should probably give it at least one to two weeks to feel some anxiety relief.

Buspar Dosage: General Information:

The Buspar dosage will vary for different patients. You should always follow your physician’s orders or the directions on the label. The following information refers only to the most common Buspar dosage. If your dose of Busbar is different however, you should not change it unless your doctor tells you to do so. The number of tablets you take depends upon your specific requirements.

Buspar Dosage Oral Form (tablets):

Adults

Usually start at 5 mg. two or three times a day, or 7.5 mg. two times a day. Your physician may increase your Buspar dosage by 5 mg. a day every few days if needed. However, the dose is usually not more than 60 mg. per day.

Children up to 18 years of age.

The use and dosage must be determined by your doctor.

Older Adults:

Usually start your dosage of Busbar at 5 mg., two or three times a day, or 7.5 mg. two times a day. Your doctor may increase your individual dosage by 5 mg. a day every few days if necessary.

Missed doses:

If you miss your dosage of Buspar you should take it as soon as possible. However, if it is almost time for you to take your next dose, you should go back your regular dosing schedule. You should never take two doses of Buspar.

Symptoms of Overdosage from Busbar:

Lightheadedness or dizziness; drowsiness (severe) or loss of consciousness; stomach upset, including nausea or vomiting; very small pupils in the eyes.

Any medication taken in excess of the dosage recommended can have serious side effects. If you suspect an overdose of Busbar you should seek medical attention immediately.

Storage:

You should obviously keep Busbar out of the reach of children. Store it away from heat and direct light, and try not to store it in the bathroom, near the kitchen sink or other damp places. Heat or moisture has been known to break this medicine down.

You should never keep outdated medicine or medication that is no longer needed. Be sure that any discarded medicine is out of the reach of children.

Information adapted from The PDR Pocket Guide to Prescription Drugs and the Consumer Reports Consumer Drug Reference

Additional information and webpage by Paul Susic Ph.D. Licensed Psychologist (Health and Geriatric Psychologist)




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Other Specified Anxiety Disorder Symptoms and Related DSM–5 Diagnosis





Other Specified Anxiety Disorder 300.09 (F41.8):

Information related to Other Specified Anxiety Disorder as well as the specific symptoms follow below. While some of these Other Specified Anxiety Disorder symptoms may be recognized by family, teachers, legal and medical professionals, and others, only properly trained mental health professionals (psychologists, psychiatrists, professional counselors etc.) can or should even attempt to make a mental health diagnosis.




A multitude of factors are considered in addition to the psychological symptoms in making a proper diagnosis, including medical and psychological testing considerations. This information is for information purposes only and should never replace the judgment and comprehensive assessment of a trained mental health clinician.

Other Specified Anxiety Disorder diagnostic criteria 300.09 (F41.8):

This category applies to presentations in which symptoms characteristic of an anxiety disorder that causes clinically significant distress or impairment in social, occupational, or other important areas of functioning predominate but do not meet the full criteria for any of the disorders in the anxiety disorders diagnostic class. The other specified anxiety disorder category is used in situations in which the clinician chooses to communicate the specific reason that the presentation does not meet the criteria for any specific anxiety disorder. This is done by recording “other specified anxiety disorder” followed by the specific reason (e.g. “generalized anxiety not occurring more days than not”).

Examples of presentations that can be specified using the “other specified” designation include the following:

1. Limited-symptom attacks.
2. Generalized anxiety not occurring more days than not.
3. Khyal “wind attacks”:
4. Ataque de nerios (attack of nerves).

Diagnostic Information and Criterion for Anxiety Disorders adapted from the Diagnostic and Statistical Manual of Mental Disorders Fifth Edition American Psychological Association by Paul Susic Ph.D. Licensed Psychologist



Unspecified Anxiety Disorder Symptoms and Related DSM–5 Diagnosis




Unspecified Anxiety Disorder 300.00 (F41.9)

Information related to Unspecified Anxiety Disorder as well as the specific symptoms follow below. While some of these Unspecified Anxiety Disorder symptoms may be recognized by family, teachers, legal and medical professionals, and others, only properly trained mental health professionals (psychologists, psychiatrists, professional counselors etc.) can or should even attempt to make a mental health diagnosis.




A multitude of factors are considered in addition to the psychological symptoms in making a proper diagnosis, including medical and psychological testing considerations. This information is for information purposes only and should never replace the judgment and comprehensive assessment of a trained mental health clinician.

Unspecified Anxiety Disorder diagnostic criteria 300.00 (F41.9):

This category applies to presentations in which symptoms characteristic of an anxiety disorder that causes clinically significant distress or impairment in social, occupational, or other important areas of functioning predominate but do not meet the full criteria for any of the disorders in the anxiety disorders diagnostic class. The unspecified anxiety disorder category is used in situations in which the clinician chooses not to specify the reason that the criteria are not met for specific anxiety disorder, and includes presentations in which there is insufficient information to make a more specific diagnosis (e.g. in emergency room settings).

Diagnostic Information and Criterion for Anxiety Disorders adapted from the Diagnostic and Statistical Manual of Mental Disorders Fifth Edition American Psychological Association by Paul Susic Ph.D. Licensed Psychologist



300.02 (F41.1) Generalized Anxiety Disorder Symptoms and Related DSM–5 Diagnosis




300.02 Generalized Anxiety Disorder (F 41.1): An Overview

The diagnosis of generalized anxiety disorder has been part of the DSM diagnostic system since the DSM-3. It is believed to be one of the most commonly experienced anxiety disorders in the United States with approximately 2.9% of adults experiencing this condition. The key feature of generalized anxiety disorder is an excessive worry or anxiety about various events and circumstances significantly out of proportion to the actual threat involved.
One of the things that differentiates generalized anxiety disorder from other anxiety disorders is the fact that it seems to take place over a variety of circumstances and situations for more days than not over a minimum of six months. An individual experiencing this disorder finds it hard to control the anxiety and worry and includes at least three characteristic symptoms. The symptoms include sleep disturbance, restlessness or feeling on edge, difficulty concentrating or the mind going blank, easily fatigued, muscle tension, and irritability.

Special Concerns:

The key feature is a pathological sense of worry and anxiety and is easily distinguished from nonclinical levels of anxiety by the high level or intensity of the anxiety, as well as the level of impairment in an individual’s daily functioning. Somatic and physical symptoms often accompany generalized anxiety disorder and include diarrhea, nausea, sweating, dizziness, accelerated heart rate, and muscle tension. As with many anxiety disorders, women seem to be affected more often by generalized anxiety disorder than men and seem to receive this diagnosis more frequently.

In the United States, generalized anxiety disorder seems to be more often experienced by Caucasian and Native American populations and seems to be more often among younger individuals. Latinos, Asians, African-Americans and Caribbean black populations have lower levels of generalized anxiety disorder.

Generalized Anxiety Disorder Coding:

There is only one code for generalized anxiety disorder 300. 02 (F 41.1) in the DSM-5. There are no specifiers for this disorder although mental health clinicians can choose to use the with panic attacks specifier when necessary.
General information on generalized anxiety disorder as well as medication and treatment can be found on the following pages and specific criteria follow below.


Generalized Anxiety Disorder diagnostic criteria 300.02 (F41.1):




A. Excessive anxiety and worry (apprehensive expectation), occurring more days than not for at least six months, about a number of events or activities (such as work or school performance).
B. The individual finds it difficult to control the worry.
C. Anxiety and worry are associated with three (or more) of the following six symptoms (with at least some symptoms having been present for more days than not for the past six months):

Note: Only one item is required in children.

1. Restlessness or feeling keyed up or on edge.
2. Being easily fatigued.
3. Difficulty concentrating or mind going blank.
4. Irritability.
5. Muscle tension.
6. Sleep disturbance (difficulty falling or staying asleep, or restless, unsatisfying sleep).

D. The anxiety, worry, or physical symptoms cause clinically significant distress or impairment in social, occupational, or other important areas of functioning.
E. The disturbance is not attributable to the physiological effects of a substance (e.g. a drug of abuse, a medication) or another medical condition (e.g. hyperthyroidism).
F. The disturbance is not better explained by another mental disorder (e.g. anxiety or worry about having panic attacks and panic disorder, negative evaluation social anxiety disorder [ social phobia], contamination or other obsessions and obsessive-compulsive disorder, separation from attachment figures in separation anxiety disorder, reminders of traumatic events in posttraumatic stress disorder, gaining weight in anorexia nervosa, physical complaints in somatic symptom disorder, perceived appearance flaws in body dysmorphic disorder, having a serious illness in illness anxiety disorder, or the content of delusional beliefs in schizophrenia or delusional disorder).

Diagnostic Information and Criterion for Anxiety Disorders adapted from the Diagnostic and Statistical Manual of Mental Disorders Fifth Edition American Psychological Association by Paul Susic Ph.D. Licensed Psychologist