Anxiety

How do I know if I have a problem with anxiety?

First of all, anxiety - feelings of dread or panic - is quite common. Most everyone experiences some degree of it. It's not a problem until, for some reason or another, it interferes with your ability to function, either at home, in your work, at school, or just around your community. Once that's occurred, it's time to consider treatment, and Ward Halverson is uniquely trained and experienced in a variety of approaches. He hopes the following information answers most of your questions, but, as always, phone calls are welcome.

So, what is anxiety?

Anxiety is a natural emotional response to a threatening situation. Feelings of worry, nervousness or unease about an upcoming speaking engagement, exams or workplace pressures are common to all of us. Usually these feelings are reasonable and we adapt to the situation, despite how uncomfortable our initial response might be. These feelings might even last two to three weeks, depending on the stressful nature of the situation. A person may request short term treatment to help cope with the event. However this does not indicate an anxiety disorder and it is important to understand the difference between short term anxiety and an anxiety disorder.

It is estimated that 10% of people suffer from anxiety disorders and that 25% of people will experience at least one anxiety disorder in their lifetime. There are many different types of anxiety disorders. Among them are:

  • Panic Attack
  • Panic Disorder
  • Agoraphobia
  • Agoraphobia without a history of Panic Disorder
  • Panic Disorder with Agoraphobia
  • Specific Phobia (such as a particular fear of something)
  • Social Phobia
  • Post Traumatic Stress Disorder
  • Obsessive Compulsive Disorder
  • Anxiety Disorder Due to Medical Conditions
  • Substance Induced Anxiety Disorder
  • Separation Anxiety
  • Generalized Anxiety Disorder

Each of these disorders has its own specific group of symptoms, but all are characterized by excessive irrational fear and dread, or the symptoms of a panic attack, and therefore many psychological and medication treatments will be common among the disorders.

It is important to seek treatment for these conditions, realizing they are treatable medical disorders and not make the mistake of viewing them as weakness or instability of character. Interestingly enough, most of the anxiety disorders are relatively simple to treat, both with adults and children.

What are the anxiety disorders?

Panic Attack - A panic attack is not a disorder. It is a discrete period of intense fear, usually with a relatively rapid onset, building up and peaking at about 10 minutes and lasting no more than 20 to 30 minutes. People may experience heart pounding, chest pain, shortness of breath, faint, dizzy, nauseated, flushed, chilled, a sense of loss of control or going crazy, light headed, or fear of dying. Not everyone who has a panic attack has panic disorder. Some people might have just one attack and no more or attacks cued by specific situations only.

Panic Disorder - This disorder is characterized by panic attacks which occur without warning and at least some of the attacks are not associated with any specific situational cues. Panic disorder may or may not be accompanied by agoraphobia (below).

Agoraphobia - is an irrational anxiety or fear of open or public places, without the ability to get to a safe place, resulting in people avoiding those situations, performing them under extreme anxiety, or needing someone present in order to go into the situation.

Panic Disorder with Agoraphobia - Panic disorder that results in people avoiding situations for fear of a panic attack occurring and the person feels unable to escape or need to be accompanied by another person in order to go into the situation such as a grocery store, bus, driving or elevator.

Specific-phobia - Phobias are extreme or irrational fears of something. In specific phobias, this could be to animals or insects such as spiders, environmental events such as storms, seeing blood, situational events such as driving, elevators or bridges, or fears of falling or choking. Most people avoid the situation and experience anxiety when they even anticipate it, but occasionally people are willing to endure the situation although they do so with an unreasonable degree of anxiety.

Social Phobia - This is also known as Social Anxiety Disorder. This persistent fear or anxiety might be to a specific performance, or may be a more generalized phobic response to a number of social situations such as parties, participating in small group settings, public performances, public speaking, or other socially interactive situations.

Obsessive-Compulsive Disorder - This is a condition in which people are plagued by persistent unwanted thoughts (obsessions) and the felt need to do certain things (compulsions) which they find extremely difficult to control. Obsessions may be over contamination, a stove being turned off, or did they hurt someone in a traffic accident, for example, and compulsions might be repeated hand washing, checking, or counting in an attempt to relieve the anxiety symptoms.

Post Traumatic Stress Disorder - People who have experienced or seen a terrifying event in their lives such as a fatal accident, combat, rape, attack, or some natural disaster might go on to experience intense fear, helplessness or horror, reliving the terrifying experience in their minds (flashbacks or nightmares), while experiencing depression, anger or irritability. The symptoms are intense, persistent and may interfere with normal daily relationships and functioning.

Generalized Anxiety Disorder - This disorder is characterized by almost daily, excessive worry or anxiety which lasts six months or more, over a variety of situations. This anxiety is accompanied by a number of symptoms such as sleep disturbance, irritability, concentration problems, or muscle tension, restlessness, and being easily tired.

Separation anxiety disorder - Considered a disorder of children, separation anxiety disorder can be diagnosed when a child becomes extremely anxious in response to anticipating or being separated from one or more caregiving adults (usually a parent). The separation may come with the child's going to school each day or going to bed each evening, for example.

What causes anxiety?

There are a number of anxiety disorders and the symptoms of some disorders might have precipitating factors while others do not. However, the precipitating factors that cause one person to go on and develop a disorder do not necessarily develop a disorder in another person. For instance, not everyone who experiences a panic attack goes on to develop Panic Disorder, and not everyone who goes through a traumatic experience such as a war, attack, rape or is involved in or witnesses a fatal accident goes on to develop post traumatic stress disorder.

Many substances or diseases are accompanied by symptoms of anxiety, so in these cases anxiety symptoms would be deemed to be caused by the illness or substance. In anxiety disorders not associated with disease or substance use, research is going on looking at a number of possible causes.

Studies are being done on a number of different structures in the brain responsible for emotional responses such as fear and anxiety. Structures such as the amygdala, hippocampus, hypothalamus, prefrontal cortex, and brain stem to name a few, all interact to perform various critical roles in processing or interpreting of stimuli, responses to danger, traumatic memory, fear, anxiety, and the body's physiological responses to threat. Much more research needs to be done, however, to understand the interplay between these structures and to develop further understanding how each may play a significant role in a specific anxiety disorder. For instance, the locus ceruleus located in the brainstem, is the primary Norepinephrine-containing site in the brain with projections into various sites responsible for fear responses, the hippocampus is known to be important in traumatic memory, and the hypothalamus is the principle site for neuroendocrine and autonomic responses to threat. It is hoped that further understanding of these brain structures may help with development of more effective medications, and possibly with non-medication treatment options such as teaching one part of the brain to control responses from other areas. Medically, there are a several theories that propose abnormal function of a number of neurotransmitters such as serotonin, norepinephrine and gama-aminobutyric acid in these and possibly other brain structures.

Family patterns are seen in some of the disorders possibly indicating genetic causes. In addition, developmental, environmental and behavioral causes are being looked at, particularly the role of learned behaviors during childhood. The idea of a predisposition-stress model is a useful approach that Ward Halverson employs in understanding and treatment. Although the short answer is that nobody knows exactly what causes anxiety, there are a number of good theories, and probably the ultimate answer will be some combination of many factors.

What's a panic attack?

Panic attacks form the most common, basic symptoms associated with almost all forms of anxiety. They are recurrent episodes that occur separately and intensely for a relatively short period of time (usually about 10 minutes) and are associated with at least four of the following:

  • Palpitations
  • Sweating
  • Trembling
  • Shortness of breath
  • Sense of choking
  • Chest pain
  • Nausea or other stomach upset
  • Dizziness
  • A feeling of being detached from the world (derealization)
  • Being unable to think, feeling as if the mind has gone blank
  • Fear of dying
  • Numbness or tingling
  • Chills or hot flashes

What types of treatments are effective for anxiety?

Anxiety disorders respond very well to treatment, yet according to the Anxiety Disorders Association of America, only about a third of those suffering from them receive help. This is unfortunate because treatment can offer immense relief, often in a relatively short amount of time. Most anxiety disorders are treated with cognitive-behavioral therapy (CBT), medication, or a combination of the two.

What is Cognitive-Behavioral Therapy?

It's very effective in the treatment of anxiety disorders. As the name suggests, CBT focuses on changing both maladaptive thinking patterns - or cognitions - and behaviors. If you're suffering from an anxiety disorder, CBT will help you identify and challenge the negative and irrational beliefs that are holding you back from working through your fears. Another key component of CBT is exposure. In exposure therapy, you confront your fears in a safe, controlled environment. Through repeated exposures, you will gain a greater sense of control over your anxieties. As you learn new skills for dealing with stressful situations, you will begin to get the upper hand on anxiety.

Cognitive-behavior therapy for anxiety usually takes between 12 and 20 weeks, but oftentimes much less with Ward Halverson, as the techniques he uses are designed to work quickly. CBT is conducted both in individual therapy and in groups of people with similar anxiety problems.

What about medication?

A variety of medications are also used in the treatment of anxiety disorders, including traditional anti-anxiety drugs, antidepressants, and beta-blockers. Medication is sometimes used in the short-term to alleviate severe symptoms so that other forms of therapy can be pursued. Anxiety medications can be habit forming and may have unwanted side effects, so be sure to research your options.

Natural and herbal treatments can include valerian root and kava. Kava has been used to treat anxiety for many years. However, the effectiveness and safety of these products has not been well-documented. Keep in mind that some herbal remedies can make anxiety worse. Supplements may also interact with other prescription or over-the-counter drugs you are taking, so it's important to check with your doctor first. .

Are there other anxiety disorder treatments?

Yes, although they're not as well-studied. Some of the other treatments include:

  • Relaxation techniques such as progressive muscle relaxation, controlled breathing, and guided imagery may reduce anxiety. Ward Halverson uses a great deal of visualization techniques combined with hypnotherapy (below).
  • Biofeedback involves the use of sensors that measure physiological arousal brought on by anxiety (such as changes in heart rate and muscle tension). Biofeedback teaches you to recognize and control these body processes.
  • Hypnotherapy for anxiety is conducted by a clinical hypnotherapist who works with you using different therapeutic techniques while you're in a state of deep relaxation.
  • Acupuncture: long used in traditional Chinese medicine, acupuncture may help reduce anxiety.

What about prevention and self-treatment for anxiety?

Excellent! Ward Halverson puts great stock in an individual's ability to prevent, reduce, or otherwise manage a panic attack or other symptoms. A healthy and balanced lifestyle can help you control and reduce your anxiety. Here are a number of things you can do to keep anxiety at bay:

  • Exercise regularly - Exercise is a proven, effective treatment for anxiety. Yoga and aerobic activities are particularly calming, but ultimately people find what works best for them personally.
  • Get enough sleep - Lack of sleep can exacerbate anxiety.
  • Eat a healthy diet - Healthy eating can help you in your battle against anxiety and stress. Make sure your diet includes plenty of fruits and vegetables.
  • Meditate - Many types of meditation have been shown to reduce anxiety. Common types of meditation include mindfulness, walking meditation, and transcendental meditation.
  • Practice relaxation techniques - Relaxation techniques such as deep breathing and visualization can help reduce anxiety.
  • Avoid alcohol and drugs - Don't use substances to cope with your anxiety. They can make the problem worse, and eventually will cause problems of their own.
  • Eliminate caffeine - Stop drinking or cut back on caffeinated beverages, including soda, coffee, and tea. Caffeine can increase anxiety, cause insomnia, and even provoke panic attacks
  • Cultivate a support system - Spend as much time as possible with people who make you feel good and are emotionally supportive. The more social support you have from friends and family, the less vulnerable you will be to anxiety and stress.
  • Other ideas include: Talking with a supportive person, meditation, watching TV, taking a long, warm bath, resting in a dark room, and deep-breathing exercises

When should someone seek additional medical care?

If you experience any of the symptoms of anxiety, you should consult with your regular practitioner to rule out the possibility of a medical disorder. It's good advice to call your doctor, even so, when the signs and symptoms of anxiety are not easily, quickly, and clearly diagnosed and treated.

You should also contact your doctor or mental health clinician:

  • If the symptoms are so severe that you believe medication may be needed
  • If the symptoms are interfering with your personal, social, or professional life
  • If you have chest pain, shortness of breath, headaches, palpitations, dizziness, fainting spells, or unexplained weakness
  • If you are depressed and feel suicidal or homicidal
  • When the signs and symptoms suggest that anxiety may have been present for a prolonged period (more than a few days) and appear to be stable (not getting worse rapidly), you may be able to make an appointment with your doctor for evaluation. But when the signs and symptoms are severe and come on suddenly, they may represent a serious medical illness that needs immediate evaluation and treatment in a hospital's emergency department.

What about medicine?

In the past, anxiety was treated with drugs in a class known as benzodiazepines. This class of medications is currently used much less often to treat anxiety due to the possibility of addiction. Examples of medications from this group include:

  • Diazepam (Valium)
  • Alprazolam (Xanax)
  • Lorazepam (Ativan)
  • Clonazepam (Klonopin)
  • Another anti-anxiety drug that is not a benzodiazepine is buspirone (BuSpar).
  • Neurontin is an antiseizure medication that has been found to be helpful in treating anxiety for some people, but little organized research has indicated whether or not it is effective in addressing anxiety disorders.

Drugs of the SSRI class (selective serotonin reuptake inhibitors that are also used to treat depression) are sometimes prescribed and include the following:

  • Sertraline (Zoloft)
  • Paroxetine (Paxil)
  • Fluoxetine (Prozac)
  • Escitalopram (Lexapro)
  • Citalopram (Celexa)
  • Venlafaxine (Effexor): This medication has chemical properties of the SSRI class as well as blocking the reuptake of norepinephrine, another neurotransmitter.


What are some other treatment thoughts?

  • Stop or reduce your consumption of products that contain caffeine, such as coffee, tea, cola and chocolate
  • Ask your doctor or pharmacist before taking any over-the-counter medicines or herbal remedies. Many contain chemicals that can increase anxiety symptoms.
  • Exercise daily and eat a healthy, balanced diet.
  • Seek counseling and support as soon as possible after a traumatic or disturbing experience.
  • If it's applicable, work hard on your interpersonal skills in dealing with difficult people and situations, or parenting skills/training in dealing with your children
  • Understand that your initial choice of what kind of professional to see will virtually decide what kind of treatment you are offered, at least initially. If you see a psychiatrist, the chance of being offered medication is very high, and if you see a non-physician therapist, the chance of being offered the form of nonmedication treatment they most favor is very high. A good clinician will, of course, always refer you to another professional if he/she recognizes that you need a form of treatment they can't, or don't, provide.
  • Do not assume that all mental health professionals work in similar ways, or have similar training and experience, or are equally good at adapting their way of working to your particular needs. You will be much better off if you can figure out what kind of help you need, and then find someone who regularly provides that. This is not always an easy task, but it's well worth the effort.
  • Most people struggling with anxiety disorders are best served by cognitive behavioral treatment; some will need medication in addition to this, and most will not, depending on the severity of their condition and their particular diagnosis. Most people will be better off starting with the cognitive behavioral treatment first, and seeing how that works out for them before trying a medication treatment.
  • In general, the more difficulty you are having, the more you may need professional help, but only you can decide how urgent your need is. Certainly there are many good sources of self help information you can use. If you choose to try self help, I suggest you follow a few guidelines: Get a "buddy", a coach, or a support person, with whom you can discuss your efforts on a regular basis. They don't have to be an expert. A major benefit is that, by telling someone of your efforts, you will find it easier to monitor your progress and hold yourself accountable. It's easy to forget about all your good intentions when you keep them to yourself.
  • Follow an organized plan. Take a look at self help books; make one of these the basis of your work.
  • Evaluate your progress at regular intervals, at least monthly. After six months, re-evaluate your progress. If you're satisfied you're making reasonable progress, continue on course. If you're not, consider seeking professional help at that time.
  • Consider group treatment - the cost is lower and the opportunity to share experiences with others who can relate to your situation can be profound. This is particularly important for people who feel especially ashamed and imagine that they are one of a very few who suffer in this way. The problem with groups, in Herkimer County and its vicinity, is that there are few offered.
  • If you decide to get professional help, be prepared to do some work to find a good therapist. You can start by getting the names of therapists in your area who offer the kind of treatment you seek. You will be better off if you can find a therapist who has specialized training and experience with the anxiety problem for which you seek help. Once you have a list, call three or four of the therapists to ask a few questions before making your first appointment. Tell whoever answers the phone (or the voice mail) that you are a potential client looking for a therapist, and you want to ask the therapist a few questions. Do not try and disguise what you are doing - there's no need for that! You will be paying for a service, and are entitled to get the information you need to make a good choice as a consumer.
  • A therapist who is too busy to talk to you for at least a few minutes on the telephone, for free, is probably too busy to be your therapist.