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A basic concept in Cognitive Behavioral Therapy (CBT) treatment of anxiety disorders is in vivo exposure—a gradual exposure to the actual, feared stimulus. This treatment is based on the theory that the fear response has been classically conditioned and that avoidance positively reinforces and maintains that fear. This "two-factor" model is often credited to O. Hobart Mowrer. Through exposure to the stimulus, this conditioning can be unlearned; this is referred to as extinction and habituation. A specific phobia, such as fear of spiders, can often be treated with in vivo exposure and therapist modeling in one session. Obsessive compulsive disorder is typically treated with exposure with response prevention.

Social phobia has often been treated with exposure coupled with cognitive restructuring, such as in Heimberg's group therapy protocol. Evidence suggests that cognitive interventions improve the result of social phobia treatment.

CBT has been shown to be effective in the treatment of generalized anxiety disorder, and possibly more effective than pharmacological treatments in the long term. In fact, one study of patients undergoing benzodiazepine withdrawal who had a diagnosis of generalized anxiety disorder showed that those who received CBT had a very high success rate of discontinuing benzodiazepines compared to those who did not receive CBT. This success rate was maintained at 12 month follow up. Furthermore in patients who had discontinued benzodiazepines it was found that they no longer met the diagnosis of general anxiety disorder and that patients no longer meeting the diagnosis of general anxiety disorder was higher in the group who received CBT. Thus CBT can be an effective tool to add to a gradual benzodiazepine dosage reduction program leading to improved and sustained mental health benefits.

 

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Anxiety and Depression

What to Do When You Have Both

Most people feel anxious or depressed at times. Losing a loved one, getting fired from a job, going through a divorce, and other difficult situations can lead a person to feel sad, lonely, scared, nervous, or anxious. These feelings are normal reactions to life's stressors. But some people experience these feelings daily or nearly daily for no apparent reason, making it difficult to carry on with normal, everyday functioning. These people may have an anxiety disorder, depression, or both.

It is not uncommon for someone with an anxiety disorder to also suffer from depression or vice versa. Nearly one-half of those diagnosed with depression are also diagnosed with an anxiety disorder. The good news is that these disorders are both treatable, separately and together.

Anxiety Disorders

Anxiety disorders are a unique group of illnesses marked by persistent, irrational, and uncontrollable anxiety. These disorders include generalized anxiety disorder, obsessive-compulsive disorder (OCD), panic disorder, posttraumatic stress disorder, social anxiety disorder, and specific phobias.

Anxiety disorders are the most common psychiatric illnesses affecting children and adults. They may develop from a complex set of risk factors, including genetics, brain chemistry, personality, and life events.

These are the kinds of anxiety disorders that I treat:
Generalized Anxiety Disorder Generalized anxiety disorder is characterized by excessive, unrealistic worry that lasts six months or more; in adults, the anxiety may focus on issues such as health, money, or career. In addition to chronic worry, GAD symptoms include trembling, muscular aches, insomnia, abdominal upsets, dizziness, and irritability.

Obsessive-Compulsive Disorder (OCD). People suffering from OCD are plagued by persistent, recurring thoughts (obsessions) that reflect exaggerated anxiety or fears; typical obsessions include worry about being contaminated or fears of behaving improperly or acting violently. The obsessions may lead to performing a ritual or routine (compulsions), such as washing hands, repeating phrases, or hoarding, to relieve the anxiety caused by the obsession.

Panic Disorder. People with panic disorder suffer severe attacks of panic, which may make them feel as if they are having a heart attack or can't breathe, for no apparent reason. Symptoms include heart palpitations, chest pain or discomfort, sweating, trembling, tingling sensations, feeling of choking, fear of dying, fear of losing control, and feelings of unreality. Panic disorder often occurs with agoraphobia, in which people are afraid of having a panic attack in a place from which escape would be difficult, so they avoid these places.

Posttraumatic Stress Disorder. Posttraumatic stress disorder can follow an exposure to a traumatic event such as a sexual or physical assault, witnessing a death, the unexpected death of a loved one, or natural disaster. Three main symptoms are associated with PTSD: "reliving" of the traumatic event through flashbacks or nightmares; avoidance behaviors (avoiding places related to the trauma) and emotional numbing (detachment from others); and physiological arousal such difficulty sleeping, irritability, or poor concentration.

Social Anxiety Disorder (Social Phobia). Social anxiety disorder is also called social phobia. It is characterized by extreme anxiety about being judged by others or behaving in a way that might cause embarrassment or ridicule. This intense anxiety may lead to avoidance behavior. Physical symptoms associated with this disorder include heart palpitations, faintness, blushing, and profuse sweating.

Specific Phobias. People with specific phobias suffer from an intense fear reaction to a specific object or situation (examples: spiders, dogs, heights). The level of fear is usually inappropriate to the situation and it is recognized by the sufferer as being irrational. This inordinate fear can lead to the avoidance of common, everyday situations.

Anxiety disorders are highly treatable with psychosocial therapies, medication, or both.

Take the quiz if you think you be suffering from anxiety.

Depression
Depression is a condition in which a person feels discouraged, sad, hopeless, unmotivated, or disinterested in life in general. When these feelings last for a short period of time, it may be a case of "the blues." But when such feelings last for more than two weeks and when the feelings interfere with daily activities such as taking care of family, spending time with friends, or going to work or school, it's likely a major depressive episode. Major depression is a treatable illness that affects the way a person thinks, feels, behaves, and functions.

Dysthymia
Dysthymia is a less severe, long-term, and chronic form of depression. It involves the same symptoms as major depression, mainly low energy, poor appetite or overeating, and insomnia or oversleeping. It can manifest as stress, irritability, and mild anhedonia, which is the inability to derive pleasure from most activities. People with dysthymia might be thought of as always seeing the glass as half empty.

Take the quiz if you think you may be suffering with depression.

 

Courtesty of Anxiety Disorders Association of America

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Anxiety is a normal human emotion that everyone experiences at times. Many people feel anxious, or nervous, when faced with a problem at work, before taking a test, or making an important decision. Anxiety disorders, however, are different. They can cause such distress that it interferes with a person's ability to lead a normal life.
An anxiety disorder is a serious mental illness. For people with anxiety disorders, worry and fear are constant and overwhelming, and can be crippling.
What Are the Types of Anxiety Disorders?
There are several recognized types of anxiety disorders, including:
• Panic disorder : People with this condition have feelings of terror that strike suddenly and repeatedly with no warning. Other symptoms of a panic attack include sweating, chest pain, palpitations (irregular heartbeats), and a feeling of choking, which may make the person feel like he or she is having a heart attack or "going crazy."
• Obsessive-compulsive disorder (OCD) : People with OCD are plagued by constant thoughts or fears that cause them to perform certain rituals or routines. The disturbing thoughts are called obsessions, and the rituals are called compulsions. An example is a person with an unreasonable fear of germs who constantly washes his or her hands.
• Post-traumatic stress disorder (PTSD) : PTSD is a condition that can develop following a traumatic and/or terrifying event, such as a sexual or physical assault, the unexpected death of a loved one, or a natural disaster. People with PTSD often have lasting and frightening thoughts and memories of the event, and tend to be emotionally numb.
• Social anxiety disorder : Also called social phobia, social anxiety disorder involves overwhelming worry and self-consciousness about everyday social situations. The worry often centers on a fear of being judged by others, or behaving in a way that might cause embarrassment or lead to ridicule.
• Specific phobias : A specific phobia is an intense fear of a specific object or situation, such as snakes, heights, or flying. The level of fear usually is inappropriate to the situation and may cause the person to avoid common, everyday situations.
• Generalized anxiety disorder : This disorder involves excessive, unrealistic worry and tension, even if there is little or nothing to provoke the anxiety.

Courtesty of WebMD

 

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Coping With Anxiety
Tip: Change What You Can, Accept the Rest
By Jeanie Lerche Davis
WebMD Feature
Reviewed by Brunilda Nazario, MD

Divorce, layoffs, threat of terrorism -- there's plenty of anxiety around for everyone these days. And very often, the source is something we can't change. How do you know when it's time to get help dealing with your anxieties?
To better understand the underpinnings of anxiety -- and how to better cope -- WebMD turned to two anxiety experts: Jerilyn Ross, MA, LICSW, director of The Ross Center for Anxiety and Related Disorders, Inc., and Linda Andrews, MD, assistant professor of psychiatry and behavioral sciences at Baylor College of Medicine in Houston.

Normal vs. Harmful Anxiety
The cold sweat of anxiety is that "fight or flight" response that kept our early relatives safe from grizzly bears and other scary characters, says Andrews. "That adrenaline rush still serves us well under certain circumstances. Anxiety is a natural reaction to those very real stresses."
In today's world, "that reaction helps motivate us, prepares us for things we have to face, and sometimes give us energy to take action when we need to," adds Ross.

Big job interview is coming up, and it's got you in knots. So "you spend a little more time getting dressed or rehearsing what you're going to say," Ross says. "You've got an appointment with the divorce lawyer, so you do more homework. That kind of anxiety can motivate you to do better. It helps you protect yourself."

But as we know too well, sometimes it doesn't take a specific threat -- only the possibility of crisis -- to send humans into anxiety mode. "The difficulty comes in learning to tone down that automatic response -- to think, 'How serious is the danger? How likely is the threat?"says Andrews.

"The thing about anxiety is, it can take on a life of its own," she adds. "Everything becomes a potential crisis. The unthinkable has happened. So around every corner, there's the next possible disaster."

The Anxiety Toll
When anxiety is taking a toll, your body knows it. You have trouble sleeping, eating, and concentrating. You get headaches; your stomach is upset. You might even have a panic attack -- the pounding heart, a feeling of lightheadedness.

Anxiety may also feel like depression. "The two sometimes overlap," Ross says.

When anxiety becomes so overwhelming that it interferes with day-to-day activities -- when it keeps you from going places, from doing things you need to do -- that's when you need help, says Ross.

Generalized anxiety disorder is a bigger syndrome -- "like a worry machine in your head," Ross says. "If it's not one thing, it's another. You're procrastinating to the point that you're almost afraid to take a step. You're so nervous about going to your child's school to talk to the teacher, you just don't go -- you miss the appointment."

In the case of such overwhelming anxiety, "people are not making good decisions," says Ross. "They're avoiding things, or they're unable to rise to the occasion because the anxiety is too much. They're procrastinating because they can't concentrate, can't stay focused. It's really interfering with their day-to-day life. At that point, they may have a more serious anxiety problem and need professional help."

Coping With Anxiety
Tip: Change What You Can, Accept the Rest
(continued)

How Do You Cope?
To cope with plain-vanilla anxiety, "get real," as they say. "Separate out the real risks and dangers that a situation presents and those your imagination is making worse," advises Ross. It's a twist on the old adage: "Take control of the things you can, and accept those you can't change."
"Ask yourself: Where can you take control of a situation? Where can you make changes? Then do what needs to be done," she says. "What things do you simply have to accept? That's very important."

Very often, it's possible to get past an anxiety cycle with the help of friends or family -- someone who can help you sort out your problems. But when anxiety becomes overwhelming, it's time for a therapist, or perhaps medication.

Here are two strategies that therapists use to help us conquer anxiety:

Challenge negative thoughts.
Ask yourself: Is this a productive thought? Is it helping me get closer to my goal? If it's just a negative thought you're rehashing, then you must be able to say to that thought: 'Stop.' "That's difficult to do, but it's very important," Ross says.

Rather than becoming paralyzed with anxiety, here's another message you can send yourself: "I may have to take a job I don't like as much, may have to travel further than I want, but I'll do what I have to do now. At least I will have the security of income in the short term. Then I can look for something better later."
The most important thing: "to realize when you've done everything you can, that you need to move forward," Ross says.

Learn to relax.
You may even need "breathing retraining," Ross adds. "When people get anxious, they tend to hold their breath. We teach people a special diaphragmatic breathing -- it calms your system. Do yoga, meditation, or get some exercise. Exercise is a terrific outlet for anxiety."

Most of all, try not to compound your problems, adds Andrews. "When things are bad, there is a legitimate reason to feel bad," she says. "But if you don't deal with it, you're going to lose more than just a job -- you'll lose relationships, your self confidence, you could even lose technical abilities if you stay dormant in your profession. Try not to compound one stress by adding another."

Often your ability to work through anxiety -- get past it -- varies depending on the type of crisis you faced. "The more severe, the more surprising it was, the longer it's going to take to get over it," says Andrews. "You may be on autopilot for several weeks. If you're depressed, that can complicate things. In the case of divorce, it may take months to years to really get back to yourself."

But take heart. "If you're doing well in one aspect of your life -- in your work or your relationships -- you're probably on your way," she says. "Fear and anxiety are no longer running your life."

Medication for Anxiety Disorders
Medication will not cure an anxiety disorder, but it will help keep it under control. If anxiety becomes severe enough to require medication, there are a few options.

Courtesy of WebMD

 

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What Are the Symptoms of an Anxiety Disorder?
Symptoms vary depending on the type of anxiety disorder, but general symptoms include:

• Feelings of panic, fear, and uneasiness
  
• Uncontrollable, obsessive thoughts
  
• Repeated thoughts or flashbacks of traumatic experiences
  
• Nightmares
  
• Ritualistic behaviors, such as repeated hand washing
  
• Problems sleeping
  
• Cold or sweaty hands and/or feet
  
• Shortness of breath
  
• Palpitations
  
• An inability to be still and calm
  
• Dry mouth
  
• Numbness or tingling in the hands or feet
  
• Nausea
  
• Muscle tension
  
• Dizziness