When It's Not Just Nerves
Author: Stephanie Stephens
esperanza Spring 2009 Issue
"Stop worrying."
"Oh yeah, right," you say to yourself, "that'll happen." Then look around. Do you think the person next to you is totally worry-free? Not likely. Just ask criminal lawyer Tommy Thompson, who has a good grip on reality.
"We all have a weakness, perhaps not always easily identifiable," says Thompson, 60, of Port Allen, Louisiana, who has panic disorder, a major type of anxiety disorder. He knows that nobody's perfect and that his disorder does not define who he is. "I do think I'm important, good, and worthy," he says with conviction, and he's right.
Thompson has plenty of company. Approximately 40 million American adults 18 and older, or about 18.1 percent of those in this age group, have an anxiety disorder-the most common mental illness in the United States.
Because words matter, it's important to understand that "anxiety disorders" are different from "anxiety," according to Jerilyn Ross, MA, LICSW, psychotherapist, author, and director of The Ross Center for Anxiety & Related Disorders in Washington, DC. The association was formed so that people like Thompson "can know they're not alone, that they can get help, and that there's a name for what they're experiencing," says Ross, who is also president and CEO of the nonprofit Anxiety Disorders Association of America (ADAA). She points out that anxiety disorders are real, serious, and treatable, adding that the ADAA (Anxiety Disorders Association of America, ADAA, Triumph Over Anxiety, Find a Therapist) promotes early diagnosis, treatment and cure of anxiety disorders, and furthermore is committed to improving the lives of those who have such a disorder.
So if you think you might have an anxiety disorder, don't suffer in silence. Up to 90 percent of [those affected] can be effectively treated, Ross states. If you think you might have an anxiety disorder, compare your own notes with Ross's descriptions of common anxiety disorders:
Generalized Anxiety Disorder (GAD):
Some anxiety is normal and useful. However, when it's excessive, ongoing, or interferes with life, or if you're aware that your anxiety is irrational, it may be an anxiety disorder.
"A wife who has the greatest husband in the world, but who lies awake needlessly worrying about him cheating may have GAD," says Ross. Another example: "Her kids are bright and healthy, but she is preoccupied with them getting sick or flunking out of school." Overall, it's a sense of not being in control of your anxiety, even with correct information. Worrying about two or more issues for six months or more-when worry is far disproportionate to any real threat-may indicate GAD, as may physical symptoms such as muscle aches, tension, headaches, stomach aches, or insomnia.
Panic Disorder:
Seemingly unprovoked, overwhelming, and out of the blue, a panic attack occurs-and you soon fear the next one. You're driving over a bridge or simply talking on the phone. Suddenly, you experience an overwhelming sense of impending doom, terror, and fear. "You may have trouble breathing, [feel] chest tightness, a pounding heart, lightheadedness, and you think: 'I'm dying! I've got to get out of here!'" is how Ross characterizes these feelings. "It's as if you were in a room and a lion charges in: the flight or fight response."
Some of us live with panic, Ross explains. We wait for "the other shoe to drop," or we avoid places we think might bring on a panic attack, leading to agoraphobia-the fear of going into a public place like a stadium-or in extreme cases, not wanting to leave home. (One in three individuals with panic disorder develops agoraphobia.)
Social Anxiety Disorder or Social Phobia:
This disorder includes fear of self-embarrassment, or of being scrutinized or judged. Specifically, says Ross, you might avoid giving a speech or introducing yourself at a meeting. More generally, you may eschew talking to salespeople in a store or even ordering food while out to dinner, as you blush or your throat closes. "You fear others will sense your anxiety, that you might say something stupid and thus embarrass yourself."
Specific Phobias:
These are irrational, involuntary fear reactions that lead to avoidance of common, everyday places, objects, or situations-or a person endures these under tremendous stress. You may feel trapped and want to leave, Ross says, even when you know there's no threat of danger. More common phobias include fear of escalators, heights, bridges, tunnels, elevators, or spiders and other insects.
Obsessive/Compulsive Disorder (OCD):
Are you spending more than an hour a day with repetitive behaviors, or with useless, uncontrollable thoughts you can't lose that create anxiety or compulsions? "These patients are almost afraid that if they don't think about it, something bad might happen," says Ross. Other OCD examples include washing and cleaning incessantly, rechecking appliance power switches, or hoarding. One of Ross's patients kept-or hoarded-years of old newspapers. Another example: So-called well-meaning individuals who say they "love animals too much" collect too many pets. Fear of harming something or someone is fairly common with OCD.
Post-Traumatic Stress Disorder (PTSD):
If you've been exposed to or witnessed a horrific experience, "a certain amount of anxiety and symptoms are normal," Ross confirms. But if they persist for more than a month with nightmares, if you're easily startled, are having flashbacks or trouble relating to others and are feeling numb, agitated, or irritated, it may be PTSD, which differs from other disorders. "A specific trigger or stimulus really does cause PTSD," she says.
If anxiety disorders are "all in your head," it's important to realize that medications absorbed by your body provide many effective treatments, says Steven Taylor, PhD, professor of psychiatry, Faculty of Medicine, at the University of British Columbia in Vancouver. Anxiolytic drugs such as benzodiazepines were widely prescribed 10 to 20 years ago, but had addiction potential, he explains. Trycyclics with antipanic qualities (medicine that was intended to do what its name suggests) were less widely used and presented annoying side effects.
Now selective serotonin reuptake inhibitors (SSRIs) are prescribed for most all disorders except specific phobias, Taylor says. Additionally, newer selective serotonin-norepinephrine reuptake inhibitors (SNRIs) hold promise while undergoing evaluation as science seeks better treatments. "Some patients are frightened of medication, while some are wary of psychotherapy and of discussing intimate problems," he says. "Control of choices is so important, since feeling out of control is an important component of anxiety disorders."
The good news on treatment
Indeed, research shows that cognitive behavioral therapy or psychosocial intervention may be more effective than medication in the longer term, as patients learn to desensitize themselves, Taylor reports. "We used to imagine lying on the analyst's couch three hours a week for 20 years. This isn't what's involved." Only four sessions may do the trick, although a typical panic treatment program is 12 to 16 sessions. "Identifying self-defeating beliefs and the overestimation of danger is key to success here."
People dealing with anxiety disorders know they're real. And increasingly, more health-care professionals know it, too. "Happily, the primary care physician is becoming more aware of anxiety disorders, rather than treating them casually and simply prescribing a tranquilizer," says Harold Pass, PhD, associate professor, Department of Psychiatry and Behavioral Science at Stony Brook University's School of Medicine in Long Island, who is in independent practice with a specialty in anxiety management. "Doctors are much more aware that anxiety must be treated, that long-term consequences are profound, including a compromised immune system and stress-exacerbated medical illness," Pass says.
Ross agrees there's no time to waste. "Risk factors for suicide rise with untreated anxiety disorders," she says. "We need to identify and treat people early to stave off damaging physiological symptoms."
That goal has become more achievable with the "coming out" of mental disorders among media personalities, and with the availability of reliable information on the Internet. Taylor cites two inventive education and treatment resources: Birmingham, England's FearFighter.com and the Dutch site, Interapy.com.
As you learn about various anxiety disorders, you may think: "Hmmm, this sounds like me and ?€? this one, too." Comorbidity, a psychiatric term describing overlap of conditions, is common, Taylor explains. Odds are if you have one disorder, you'll have another, with unipolar depression or substance abuse being most common partners to anxiety. With GAD, it's not unusual to have panic attacks, while social anxiety may include features of OCD. PTSD frequently brings along its unwelcome cousin, panic disorder.
Unwelcome thoughts can stick like glue, Taylor says. Ironically, the steps you take to block them-with their accompanying psychological significance-actually become reminders. They keep returning to your consciousness-the exact opposite of your goal. Like it or not, he says, "that's the way our human brains are designed."
Inside and out
If you're contemplating psychotherapy for your disorder, you may be introduced to the integrative model, which is the latest trend. For many years, explains Pass, "every analyst felt he was a hammer and every patient was a nail," yet one size did not realistically fit all.
Now therapists use techniques borrowed from each of the theoretical psychotherapy models that best constitute the patient's "recipe," taking a "pinch" from disciplines like behavior therapy, cognitive behavior therapy, and interpersonal and psychodynamic therapies. Pass also successfully implements relaxation training, guided visual imagery, and self-hypnosis as treatment protocols. "All may be used in combination in a very synergistic way, so patients shouldn't be discouraged," he says. "Most anxiety disorders may definitely be treated and successfully managed," he reminds us, although not all anxiety disorders can be completely "cured."
Disorders have roots. These are indeed stressful times, says Pass, and none of us is immune, insulated, or cushioned from them. Yet when anxiety disorders affect our ability to relax-and they compromise attention, concentration, and ultimately, quality of life-it's time to take action. Research shows that symptoms are initially manifest "around critical life events," [for example] when children go to school, leave home to start a job, or when tragedy occurs."
Anxiety also carries a very strong genetic component. Tommy Thompson's father, for instance, suffered panic attacks, as do his two daughters now, and he believes responses are also learned. "I try never to tell the children 'be careful.' Instead, I encourage them to 'have fun,'" he says.
Physiologically, if a family member responded to a certain medication, genetics suggest the same will be true of a relative, or, conversely, "if that person had side effects [to a medication], the relative is not going to respond as well, either," says Pass. "The brain plays a very important role in the way anxiety disorders manifest and respond to treatment. We know it is influenced by genetics and one's environment, so we manage the brain with psychological and pharmacological treatment and intervention, which should include the most recent and sophisticated developments in drug therapy."
Besides taking advantage of consistent advancements in health-care resources, we can also help ourselves. Yes, it's perfectly okay and not too egocentric for this to be "all about you," as you take charge of your own piece of the treatment pie.
"Our bodies, when stressed, have no place to turn but inwards," observes Ross, who advises doing more "to give anxiety a place to go." In addition to breathing, aerobics, and stress management classes, yoga and meditation also help encourage that much-needed sense of control. So eat, sleep, and exercise correctly, while resisting the temptation to self-medicate. In so doing, "you'll provide yourself a welcome sense of self-mastery."
As with any life challenge, however, bumps in the road are bound to occur. No one says the trip to controlling anxiety disorders will always be easy, something a resilient Thompson understands as he navigates his continuing recovery. "I tell myself, 'This panic disorder is just a disease. None of this is real.' I am stronger than it is," he says.
"Inside of me is Superman. Sometimes, I just can't find him."
Author: Stephanie Stephens
esperanza Spring 2009 Issue
"Stop worrying."
"Oh yeah, right," you say to yourself, "that'll happen." Then look around. Do you think the person next to you is totally worry-free? Not likely. Just ask criminal lawyer Tommy Thompson, who has a good grip on reality.
"We all have a weakness, perhaps not always easily identifiable," says Thompson, 60, of Port Allen, Louisiana, who has panic disorder, a major type of anxiety disorder. He knows that nobody's perfect and that his disorder does not define who he is. "I do think I'm important, good, and worthy," he says with conviction, and he's right.
Thompson has plenty of company. Approximately 40 million American adults 18 and older, or about 18.1 percent of those in this age group, have an anxiety disorder-the most common mental illness in the United States.
Because words matter, it's important to understand that "anxiety disorders" are different from "anxiety," according to Jerilyn Ross, MA, LICSW, psychotherapist, author, and director of The Ross Center for Anxiety & Related Disorders in Washington, DC. The association was formed so that people like Thompson "can know they're not alone, that they can get help, and that there's a name for what they're experiencing," says Ross, who is also president and CEO of the nonprofit Anxiety Disorders Association of America (ADAA). She points out that anxiety disorders are real, serious, and treatable, adding that the ADAA (Anxiety Disorders Association of America, ADAA, Triumph Over Anxiety, Find a Therapist) promotes early diagnosis, treatment and cure of anxiety disorders, and furthermore is committed to improving the lives of those who have such a disorder.
So if you think you might have an anxiety disorder, don't suffer in silence. Up to 90 percent of [those affected] can be effectively treated, Ross states. If you think you might have an anxiety disorder, compare your own notes with Ross's descriptions of common anxiety disorders:
Generalized Anxiety Disorder (GAD):
Some anxiety is normal and useful. However, when it's excessive, ongoing, or interferes with life, or if you're aware that your anxiety is irrational, it may be an anxiety disorder.
"A wife who has the greatest husband in the world, but who lies awake needlessly worrying about him cheating may have GAD," says Ross. Another example: "Her kids are bright and healthy, but she is preoccupied with them getting sick or flunking out of school." Overall, it's a sense of not being in control of your anxiety, even with correct information. Worrying about two or more issues for six months or more-when worry is far disproportionate to any real threat-may indicate GAD, as may physical symptoms such as muscle aches, tension, headaches, stomach aches, or insomnia.
Panic Disorder:
Seemingly unprovoked, overwhelming, and out of the blue, a panic attack occurs-and you soon fear the next one. You're driving over a bridge or simply talking on the phone. Suddenly, you experience an overwhelming sense of impending doom, terror, and fear. "You may have trouble breathing, [feel] chest tightness, a pounding heart, lightheadedness, and you think: 'I'm dying! I've got to get out of here!'" is how Ross characterizes these feelings. "It's as if you were in a room and a lion charges in: the flight or fight response."
Some of us live with panic, Ross explains. We wait for "the other shoe to drop," or we avoid places we think might bring on a panic attack, leading to agoraphobia-the fear of going into a public place like a stadium-or in extreme cases, not wanting to leave home. (One in three individuals with panic disorder develops agoraphobia.)
Social Anxiety Disorder or Social Phobia:
This disorder includes fear of self-embarrassment, or of being scrutinized or judged. Specifically, says Ross, you might avoid giving a speech or introducing yourself at a meeting. More generally, you may eschew talking to salespeople in a store or even ordering food while out to dinner, as you blush or your throat closes. "You fear others will sense your anxiety, that you might say something stupid and thus embarrass yourself."
Specific Phobias:
These are irrational, involuntary fear reactions that lead to avoidance of common, everyday places, objects, or situations-or a person endures these under tremendous stress. You may feel trapped and want to leave, Ross says, even when you know there's no threat of danger. More common phobias include fear of escalators, heights, bridges, tunnels, elevators, or spiders and other insects.
Obsessive/Compulsive Disorder (OCD):
Are you spending more than an hour a day with repetitive behaviors, or with useless, uncontrollable thoughts you can't lose that create anxiety or compulsions? "These patients are almost afraid that if they don't think about it, something bad might happen," says Ross. Other OCD examples include washing and cleaning incessantly, rechecking appliance power switches, or hoarding. One of Ross's patients kept-or hoarded-years of old newspapers. Another example: So-called well-meaning individuals who say they "love animals too much" collect too many pets. Fear of harming something or someone is fairly common with OCD.
Post-Traumatic Stress Disorder (PTSD):
If you've been exposed to or witnessed a horrific experience, "a certain amount of anxiety and symptoms are normal," Ross confirms. But if they persist for more than a month with nightmares, if you're easily startled, are having flashbacks or trouble relating to others and are feeling numb, agitated, or irritated, it may be PTSD, which differs from other disorders. "A specific trigger or stimulus really does cause PTSD," she says.
If anxiety disorders are "all in your head," it's important to realize that medications absorbed by your body provide many effective treatments, says Steven Taylor, PhD, professor of psychiatry, Faculty of Medicine, at the University of British Columbia in Vancouver. Anxiolytic drugs such as benzodiazepines were widely prescribed 10 to 20 years ago, but had addiction potential, he explains. Trycyclics with antipanic qualities (medicine that was intended to do what its name suggests) were less widely used and presented annoying side effects.
Now selective serotonin reuptake inhibitors (SSRIs) are prescribed for most all disorders except specific phobias, Taylor says. Additionally, newer selective serotonin-norepinephrine reuptake inhibitors (SNRIs) hold promise while undergoing evaluation as science seeks better treatments. "Some patients are frightened of medication, while some are wary of psychotherapy and of discussing intimate problems," he says. "Control of choices is so important, since feeling out of control is an important component of anxiety disorders."
The good news on treatment
Indeed, research shows that cognitive behavioral therapy or psychosocial intervention may be more effective than medication in the longer term, as patients learn to desensitize themselves, Taylor reports. "We used to imagine lying on the analyst's couch three hours a week for 20 years. This isn't what's involved." Only four sessions may do the trick, although a typical panic treatment program is 12 to 16 sessions. "Identifying self-defeating beliefs and the overestimation of danger is key to success here."
People dealing with anxiety disorders know they're real. And increasingly, more health-care professionals know it, too. "Happily, the primary care physician is becoming more aware of anxiety disorders, rather than treating them casually and simply prescribing a tranquilizer," says Harold Pass, PhD, associate professor, Department of Psychiatry and Behavioral Science at Stony Brook University's School of Medicine in Long Island, who is in independent practice with a specialty in anxiety management. "Doctors are much more aware that anxiety must be treated, that long-term consequences are profound, including a compromised immune system and stress-exacerbated medical illness," Pass says.
Ross agrees there's no time to waste. "Risk factors for suicide rise with untreated anxiety disorders," she says. "We need to identify and treat people early to stave off damaging physiological symptoms."
That goal has become more achievable with the "coming out" of mental disorders among media personalities, and with the availability of reliable information on the Internet. Taylor cites two inventive education and treatment resources: Birmingham, England's FearFighter.com and the Dutch site, Interapy.com.
As you learn about various anxiety disorders, you may think: "Hmmm, this sounds like me and ?€? this one, too." Comorbidity, a psychiatric term describing overlap of conditions, is common, Taylor explains. Odds are if you have one disorder, you'll have another, with unipolar depression or substance abuse being most common partners to anxiety. With GAD, it's not unusual to have panic attacks, while social anxiety may include features of OCD. PTSD frequently brings along its unwelcome cousin, panic disorder.
Unwelcome thoughts can stick like glue, Taylor says. Ironically, the steps you take to block them-with their accompanying psychological significance-actually become reminders. They keep returning to your consciousness-the exact opposite of your goal. Like it or not, he says, "that's the way our human brains are designed."
Inside and out
If you're contemplating psychotherapy for your disorder, you may be introduced to the integrative model, which is the latest trend. For many years, explains Pass, "every analyst felt he was a hammer and every patient was a nail," yet one size did not realistically fit all.
Now therapists use techniques borrowed from each of the theoretical psychotherapy models that best constitute the patient's "recipe," taking a "pinch" from disciplines like behavior therapy, cognitive behavior therapy, and interpersonal and psychodynamic therapies. Pass also successfully implements relaxation training, guided visual imagery, and self-hypnosis as treatment protocols. "All may be used in combination in a very synergistic way, so patients shouldn't be discouraged," he says. "Most anxiety disorders may definitely be treated and successfully managed," he reminds us, although not all anxiety disorders can be completely "cured."
Disorders have roots. These are indeed stressful times, says Pass, and none of us is immune, insulated, or cushioned from them. Yet when anxiety disorders affect our ability to relax-and they compromise attention, concentration, and ultimately, quality of life-it's time to take action. Research shows that symptoms are initially manifest "around critical life events," [for example] when children go to school, leave home to start a job, or when tragedy occurs."
Anxiety also carries a very strong genetic component. Tommy Thompson's father, for instance, suffered panic attacks, as do his two daughters now, and he believes responses are also learned. "I try never to tell the children 'be careful.' Instead, I encourage them to 'have fun,'" he says.
Physiologically, if a family member responded to a certain medication, genetics suggest the same will be true of a relative, or, conversely, "if that person had side effects [to a medication], the relative is not going to respond as well, either," says Pass. "The brain plays a very important role in the way anxiety disorders manifest and respond to treatment. We know it is influenced by genetics and one's environment, so we manage the brain with psychological and pharmacological treatment and intervention, which should include the most recent and sophisticated developments in drug therapy."
Besides taking advantage of consistent advancements in health-care resources, we can also help ourselves. Yes, it's perfectly okay and not too egocentric for this to be "all about you," as you take charge of your own piece of the treatment pie.
"Our bodies, when stressed, have no place to turn but inwards," observes Ross, who advises doing more "to give anxiety a place to go." In addition to breathing, aerobics, and stress management classes, yoga and meditation also help encourage that much-needed sense of control. So eat, sleep, and exercise correctly, while resisting the temptation to self-medicate. In so doing, "you'll provide yourself a welcome sense of self-mastery."
As with any life challenge, however, bumps in the road are bound to occur. No one says the trip to controlling anxiety disorders will always be easy, something a resilient Thompson understands as he navigates his continuing recovery. "I tell myself, 'This panic disorder is just a disease. None of this is real.' I am stronger than it is," he says.
"Inside of me is Superman. Sometimes, I just can't find him."
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