Anxiety is a normal reaction to stress, and we all experience it.  At low to moderate levels it is not a “disorder”. It can actually be motivating, as in when it helps us prepare for a test, or adaptive, as in when it alerts us to real or present danger. At high, constant levels though, where anxiety begins to disrupt our normal routine and relationships, it becomes impairing. At this point it becomes necessary to find out more and seek help.

There are six main types of anxiety disorders and symptoms vary from person to person.

You may have an anxiety disorder if you:

  • Experience constant worry, feel tension in your back and shoulders, have difficulty sleeping, feel restless, edgy and irritable (Generalized Anxiety).
  • Often feel sudden heart palpitations, difficulty breathing, intense dread, shaking, nausea, dizziness, chest pain, like you are losing control, or a sensation of choking, with or without a fear of leaving your house  (Panic Disorder).
  • Have uncontrollable, repetitive thoughts such as fear of germs or dirt, are plagued by recurring distressing images, or feel an urge to perform rituals (e.g., hand washing, checking) to ward off anxiety or dread (Obsessive Compulsive Disorder, or OCD).
  • Feel unreasonably fearful and distressed by social situations where you could be watched or judged by others, such as meeting new people, eating or drinking in front of others, speaking publicly, or being the center of attention (Social Anxiety).
  • Experience intense fear of a specific situation (e.g., flying, bridges, tunnels, elevators), animals (e.g., insects, dogs, reptiles), or natural phenomena (e.g., storms, heights) and feel panic in any of these situations (Specific Phobia).
  • Experience PTSD, as discussed above (LINK).

People often live with anxiety for quite some time before seeking help. Whether or not you have felt the symptoms described above with the intensity or time duration required for a diagnosis of a “disorder”, if you answered “yes” to any, you are likely experiencing distress and would benefit from treatment.  If you think you have an anxiety disorder and want to learn more, I recommend reading about them here. This website is comprehensive and has many helpful links:

This web link has thorough descriptions and interesting personal accounts of anxiety disorders:

Why do people develop anxiety?

While anxiety does not have a specific “cause”, there are a number of factors which make it more likely. These include external factors such as prolonged or accumulating stressors, a new, severe stress such as a medical diagnosis or a loss, or certain medications or foods which have psychoactive substances (e.g., too much caffeine, taking decongestants which have stimulants that can mimic panic symptoms).  Dan Stein, MD, and Eric Hollander, MD, two psychiatrists who specialize in anxiety and who have written the comprehensive 2009 Textbook of Anxiety Disorders, discuss five factors which may predispose people to anxiety. These are:

Genetics – predisposition to anxiety can be inherited. In my practice, I have worked with anxious clients who say that they have a family history of the kind of symptoms they experience.  Panic, phobias and OCD are common in first degree relatives.

Medical problems – initially, when seeking treatment, it is important to obtain a physical check-up to rule out an underlying medical condition or drug interaction that could cause or exacerbate these symptoms.

Trauma – experiencing trauma, especially child maltreatment at developmentally sensitive times can render people more likely to experience nervous system activation and anxiety reactions in situations which are similar to the original  stressor, or “triggers”.

Absence of coping – people who have grown up in neglectful homes or where their caregivers did not provide them with psychological resources may not have developed the internal psychological strategies they need to help cope with threatening situations.

Irrational thoughts and cognitive errors – a cognitive model places emphasis on thought processes. People can develop unrealistic, underlying beliefs about a threat or danger which when triggered by a similar event, which then fuel a cascade of thoughts, behaviors and emotions which all reinforce the underlying unrealistic belief.

Treatment for Anxiety Disorders

Psychotherapy is highly effective for anxiety disorders, and there are numerous studies which provide evidence for this. Generally, you might feel considerably better just from speaking with a psychotherapist about what you have been experiencing.  There are also many studies which provide evidence for the effectiveness of medication. As Edmund Bourne, PhD, stresses in his helpful 2011 Anxiety and Phobia Workbook, since there are many types of anxiety disorders, treatment may differ depending on your symptoms and the levels at which they manifest most severely. Since these can comprise thoughts, feelings, behaviors and body states, comprehensive treatment which involves all levels is most effective.

Psychotherapy for anxiety disorders can include psychodynamic, cognitive and behaviorally focused therapies, exposure therapy, deep physical relaxation, which may include mindfulness meditation and working with breath, and psychoeducation.

My Approach to Treatment for Anxiety and Panic

When clients seek treatment with me for anxiety I tend to keep a very open mind while we explore their concerns, for three main reasons. First, anxiety disorders and their chief symptoms are broad and varied.

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Other Approaches to Treatment for Anxiety and Panic

Psychotherapy for anxiety disorders can include psychodynamic, cognitive and behaviorally focused therapies, exposure therapy, deep physical relaxation, which may include mindfulness meditation and working with breath, and psychoeducation.

Read More