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Anxiety 101: What is essential for you to know?

Anxiety: An overview

When trying to understand what anxiety is, many people really don’t differentiate very well between what it is and what isn’t. A good example might be in defining the difference between fear and anxiety which would have several different features. When individuals are afraid, their fear is usually directed toward some specific situation or external object. You might fear failing in sports or in an exam, or being unable to pay bills or any number of things related to specific circumstances or individuals. When you experience anxiety you often times can’t really be specific about the source of your anxiety. You experience more of an internal sensation rather than external. It may be a reaction to a unrecognizable or vague danger. Many times people feel an internal sensation of losing control over yourself or a situation.

Anxiety: The whole body effect

Anxiety may affect your whole body. Many people describe it as having psychological, physical and behavioral effects. On a psychological level, anxiety is an internal sensation of uneasiness and apprehension. In an extreme form that may cause you to fill detached from yourself or you may even feel fearful of going crazy or dying. On a physiological level you may feel anxiety in the form of specific bodily reactions such as sweating, dry mouth, rapid heartbeat, and muscle tension. On the behavioral level it can absolutely undermine your ability to express yourself or deal with certain circumstances that are essential to your daily life.

The fact that anxiety may affect you on these three different levels makes it much more difficult to reduce the debilitating effects. Some psychologists have found that a more complete program of recovery from an actual anxiety disorder must be to intervene at all three levels to:

(1) Reduce your physiological reactivity.
(2) Eliminate behavioral avoidance.
(3) Change the internal representations which continue the state of apprehension and worry such as through the use of “self talk”.

Anxiety and Anxiety Disorders:

Anxiety and what we define as anxiety disorders appear in many different forms and levels of intensity. It can be manifested in anything from a small worry and a subjective feeling of uneasiness to severe anxiety culminating in a panic attack with symptoms such as disorientation, heart palpitations and even a sense of terror. Anxiety that comes out of the blue with no warning is referred to often as free-floating anxiety or in very severe instances a spontaneous panic attack. The difference between these two spontaneous episodes of either free-floating anxiety or spontaneous panic attack may be defined by whether you experience four or more of the following symptoms at the same time. The experiencing of four or more of the following symptoms may define a panic attack:

• Trembling or shaking
• Sweating
• Choking
• Heart palpitations
• Shortness of breath
• Numbness
• Nausea or abdominal distress
• Hot flashes or chills
• Dizziness unsteadiness
• Feeling of detachment
• Fear of going crazy or that you are out of control
• Fear of dying

Anxiety and anxiety disorders are usually differentiated between how specific they are to certain specific
circumstances or are generalizable to many situations. If your anxiety arises only related to specific circumstances it is called a situational anxiety or phobic anxiety. Situational anxiety is very different from every day fears in that it tends to be very unrealistic and out of proportion to the specific circumstances but is not debilitating. For example, if you have an apprehensive feeling about confronting others, going to the doctor or driving on the freeway it may qualify as a situational anxiety. Situational anxieties become phobias when the anxiety is high enough in intensity that you begin to avoid those specific circumstances or situations. If you absolutely avoid confronting others, going to the doctors or driving on the freeway, you may have developed a phobia due to the persistent avoidance of the specific situation.

Anxiety: It’s the thought that counts

Unfortunately, anxiety can also be brought on by thinking about the situation. If you become severely distressed by merely the thought of what may happen when you have to face one of your phobic situations, you may be developing what is referred to as anticipatory anxiety. If the level of distress is not too severe, your anticipatory anxiety may be unable to be distinguished from ordinary worrying. Sometimes however, anticipatory anxiety can become very severe and may be referred to as anticipatory panic.

There are some very important distinctions between spontaneous anxiety (or panic) and anticipatory anxiety (or panic). If you have spontaneous anxiety, it has a tendency to come out of the blue and hit its peak very rapidly and has a tendency to subside. Studies have found that the peak in intensity is usually reached within five minutes, which then subsequently seems to be followed by a gradual tapering off over an hour or more. Anticipatory anxiety however, tends to gradually build up in response to either thinking about or encountering a threatening situation and then usually drops off quickly. Frequently, people will “worry themselves to death” about something for an hour or two and then seem to let go of the worry as you find something else to occupy your mind.

Anxiety in conclusion:

It’s not enough just to say that we are anxious and just expect it to be resolved somehow. In order to have any type of understanding and resolution we have to define the specific circumstance of anxiety and how it is manifested in various forms which ultimately could even become an anxiety disorder. Anxiety disorders are much more intense and disabling then the every day experiencing of anxiety, fear or stress

By Paul Susic Ph.D, licensed psychologist

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Generalized Anxiety Disorder Overview: Must Know Information

Fundamentals of Generalized Anxiety Disorder:

Generalized Anxiety Disorder is most frequently identified by its recurrent, prolonged pattern of excessive anxiety and worry. Individuals with this anxiety disorder usually agonize over relatively expected concerns including daily finances, health, family concerns, responsibilities at work, or even such minor issues as car repairs and household chores.

The focus of worries and anxiety may frequently shift back and forth between several different concerns and the sensations may vary between dread, terror and mild tension.

Some studies have found that Generalized Anxiety Disorder may affect between 2% and 3% of the general population. For many individuals with this disorder, they are aware that the intensity, duration and frequency of their worries and anxiety may be well out of proportion with the actual circumstances or precipitating event. Given this awareness, they still have a tremendous difficulty in controlling or limiting this uncomfortable sensation. Constant worry or anxiety can impair an individual’s ability to concentrate and may affect their memory and even decision-making ability. These concerns also may lead to a loss of confidence over a period of time. Everyday activities such as socializing with others and maintaining relationships or even working consistently may become very difficult and sometimes even impossible.

This anxiety disorder may also produce an intense range of physical symptoms such as heart palpitations, nausea, headaches and unusual sweating. Many people who have this disorder do not realize that it is actually very treatable. They frequently assume that their intense feelings of anxiety are normal and are reluctant to seek treatment. Unfortunately, constant anxiety and worry can also lead to drug abuse and alcoholism. Some people do not seek treatment until they have had intense and prolonged physical discomfort for an extended period of time resulting in possibly alcoholism or drug abuse.

Treatment for Generalized Anxiety Disorder:

Although Generalized Anxiety Disorder is developed over a long period of time and has a chronic nature, it actually responds to treatment better than some other anxiety disorders such as Panic Disorder and Obsessive-Compulsive Disorder. Also, relaxation techniques such as deep breathing and or meditation have been found to relieve the symptoms of Generalized Anxiety Disorder.
Venlafaxine (Effexor) and paroxetine (Paxil) have both been approved by the FDA to treat Generalized Anxiety Disorder. Some other classifications of medications are also used to treat this anxiety disorder including serotonin norepinephrine reuptake inhibitors, SSRIs, tricyclics, and benzodiazepines such as alprazolam (Xanax) and diazepam (Valium).

As with many of the other anxiety disorders, prolonged symptoms of Generalized Anxiety Disorder can sometimes lead to depression and drug or alcohol abuse. Also, some anxiety medications such as benzodiazepines should be limited to a short course of treatment to avoid dependence and tolerance and can be a relatively serious concern when used for more than a short period of time. Antidepressants and buspirone are frequently better choices because they do not cause dependence, tolerance and withdrawal symptoms.
Psychotherapy such as cognitive behavioral treatment is also frequently used and is very effective for helping individuals with Generalized Anxiety Disorder. Psychologists and other mental health professionals are frequently able and willing to assist with individuals experiencing Generalized Anxiety Disorder.

By Paul Susic Ph.D. Licensed Psychologist

Inspired by the Johns Hopkins Medical Guide to Health after 50

Panic Disorder 101: What do I really need to know?

Panic Disorder Overview:

Some of the main characteristics of panic disorder are short-term, sudden, intense feelings of fear, terror or sense of losing control and begin without warning during activities that are believed to be nonthreatening. Many individuals experiencing panic disorder go to the emergency room because of the intensity of their physical symptoms which may include a rapid heartbeat, breathing difficulty and sometimes a choking sensation giving the appearance of a possible heart attack. Many patients believe that they are having a heart attack and need to consult a doctor immediately.

Panic attacks usually peak within approximately 10 minutes and they seem to go away over a 20 to 30 minute period of time. Panic attacks are usually characterized by a combination of at least several of the following symptoms:

• hyperventilation or shortness of breath
• discomfort in the chest
• dizziness or feeling faint
• trembling or shaking
• Heart palpitations
• stomach pain, nausea or choking
• cold or hot flashes
• tingling or numbness
• a sense of feeling detached from one’s surroundings
• a fear of dying or losing your mind.

Many individuals with panic disorder also experience other symptoms of anxiety as well as depression. While some patients will have some relief from antidepressant medications from their symptoms of depression and panic attacks, others may need totally different medications for a panic disorder than would usually be given for depression and anxiety.

Prevalence of panic disorder:

Estimates of the prevalence of panic disorder are usually between 1% and 2% among both men and women. The first attacks frequently begin in the late teens or early 20’s and will frequently go for a significant period of time misdiagnosed, undiagnosed and often untreated. Some studies have found that as few as one in four people with a potential diagnosis of panic attacks or panic disorder receive appropriate care.

Panic attacks and Agoraphobia:

Agoraphobia can be one of the most common complications associated with panic disorder. The symptoms of agoraphobia include fear of being in public places alone, and future attempts to avoid situations that are triggered by panic attacks in the past. If untreated, Agoraphobia and panic attacks can tremendously restrict an individual’s activities and lifestyle, since they will tend to avoid situations that may result in another panic attack. Another negative byproduct of panic disorder is that it may frequently increase the risk for depression, alcohol and drug dependency and even possibly suicide.

Treatment for Panic Disorder:

Treatment for panic disorder frequently involves a combination of psychotherapy and psychiatric medications. Successful treatment may necessitate being referred to a therapist that specializes in treatment of panic disorder or anxiety disorders. Many studies have found support for the effectiveness of cognitive and behavioral therapy that involves incremental exposure to situations that provoke symptoms of anxiety or panic.

Tricyclic antidepressants and MAO inhibitors seem to currently be the mainstream psychopharmacological intervention for panic disorder. These medications have been identified to be approximately 80% to 90% effective in blocking panic attacks. However, they’ve also been found to frequently take between 6 to 12 weeks to be effective. Alprazolam (Xanax), a benzodiazepine, has been found to be effective within several days and cause fewer side effects than the antidepressants. Unfortunately, Xanax can be very addictive as with all the other benzodiazepines. Also unfortunately, a relapse of panic symptoms can occur in anywhere from 30% to 60% of patients within 6 to 12 months after medications have been discontinued. Additionally, the SSRI’s such as Zoloft and Paxil have been approved by the FDA for the treatment of symptoms of panic disorder. Beta blockers can also reduce the physical symptoms of panic attacks but do not eliminate the fear or the actual panic itself.

By Paul Susic Ph.D. Licensed Psychologist

What is the difference between anxiety and anxiety disorders?

Anxiety overview:

Anxiety is a normal part of our daily experience and may be sometimes be useful in improving a person’s performance when experiencing many of life’s challenges. Some people however feel that anxiety can get out of control and cause severe discomfort and difficulty in their lives.

Anxiety disorders are different from anxiety in that they are usually characterized by frequent, persistent and sometimes recurrent physical symptoms that interfere with normal everyday functioning. They may continue even in the absence of the precipitating stressors and may appear as excessive responses to these antecedents. According to research, anxiety disorders can possibly result from hyperactivity in certain areas of the brain or potentially due to a decrease in activity of specific neurotransmitters referred to as gamma-aminobutyric acid (GABA), which is believed to suppress the action of specific neurons in the brain.

Some types of anxiety began to appear during adolescence or early adulthood, although it may occur at any time including in mature adults. Researchers have found that as many as 20% of individuals 65 and older have symptoms of anxiety that require them to seek treatment.

Medical conditions and drugs may mimic or cause anxiety disorders.

There are some conditions and even drugs that can either mimic the symptoms of anxiety or even cause it at times. These medical conditions include deficiency in folate or vitamin B12, overactive thyroid, heart attack, asthma, and alcohol withdrawal. Also, drugs might cause or mimic specific anxiety symptoms including bronchodilators, such as ephedrine (which is frequently found in weight loss drugs) or epinephrine. Also, there are some psychostimulants such as methylphenidate (Ritalin) and thyroid hormones which may cause or exacerbate underlying anxiety.

Common symptoms of anxiety:

Some of the more common psychological symptoms of anxiety include irritability, worry, intense fear, and frequently difficulty concentrating. These symptoms also may be accompanied by physical symptoms such as restlessness, trembling, muscle tension, palpitations, chills, dizziness, dry mouth or sweating.

Symptoms of anxiety disorders:

As previously stated, anxiety disorders are more than common anxiety. They usually cause a heightened awareness of symptoms and sometimes an increase in disability or functioning in an individual’s normal, everyday life. Anxiety disorders are usually broken down into various anxiety states including panic disorder, generalized anxiety disorder, obsessive-compulsive disorder, posttraumatic stress disorder and phobic disorders.

By Paul Susic Ph.D. Licensed Psychologist

Some information from The Johns Hopkins Medical Guide to Health After 50

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