Anxiety Overview:

• Anxiety can cause you to feel activated, agitated, fearful, and even angry.
• Anxiety is a normal, human experience, and it’s sometimes even
  healthy. Just because you have anxiety, that doesn’t mean you have a
  disorder.
• Anxiety can be the culprit of physical symptoms like shakiness, a racing heartbeat, or sweating.
• Anxiety is treatable. If you’re suffering from anxiety, many providers can offer you effective treatment.

What is Anxiety (and what are the signs)?

Remember how we said anxiety is part of the normal human experience? It’s true!

Many, many years ago, before the advent of grocery stores and restaurants, we regularly put our lives on the line in our quests for food. If (or when) we were confronted with a lion, tiger, or bear, our brains would register danger.

Have you heard of the phrase, “fight, flee, or freeze?” This response is our body’s natural reaction to danger. It helps us react to and recognize threats, like a lion, tiger, or bear.

Thankfully, we don’t have to worry about fending off wild animals when we grocery shop, but we still experience anxiety. Why? In the modern era, it’s the equivalent of smelling smoke in a building and fleeing to safety. Basically, there’s an evolutionary benefit to anxiety. It’s meant to keep us alive.

Is stress different from anxiety?

Although stress can seem or feel similar to anxiety, there is a difference. Stress is tension. Generally, stress is a response to something external, like work stress or conflicts with friends or family.

If you’re experiencing prolonged, chronic stress, there are many ways to manage and reduce your symptoms, including exercise, breathing exercises, adequate sleep and social connections. Stress can be uncomfortable, but just like anxiety, it’s not all bad.

Stress can be motivating. It can help us finish big school reports. Stress might help you push through the end of your long run. When you’re presenting a big presentation at work, stress might be what carries you through! Most people experience stress and anxiety at some point in their lives.

Is panic different from anxiety?

Panic is both similar to and different from anxiety and stress. Panic is the sudden onset of uncontrollable fear or anxiety in response to a particular stimulus. It can be very difficult to manage in the moment.

Even just thinking of having a panic attack can cause panic attack.

Sometimes, panic attacks can feel like heart attacks, which can be really scary in the moment. Then, the panic loop starts:

Thinking about a panic attack → start of panic attack → thoughts and feelings about fear of dying → feeling like you’re having a heart attack and dying → and rinse and repeat at an extraordinary rate in your mind until…

a full-blown panic attack.

The helpful news in all of this is that help is here. There are many effective treatments for anxiety disorders.

What are examples of anxiety disorders?

In order to understand anxiety disorders, it may be helpful to establish the definition of disorder.

A mental health disorder is one that affects the thinking, feeling, behavior or mood of a person. While anxiety is part of being human, what defines a condition as a disorder is when it begins to interfere with daily life.

Here are some examples of disorders tied to anxiety and their symptoms:

What is Generalized Anxiety Disorder?

Generalized Anxiety Disorder (GAD) is a condition categorized by: 

1. Excessive worrying that the person feels unable to control
2. Feeling tense and on edge
3. Feeling tired or experiencing fatigue more than usual
4. Increased agitation and irritability
5. Difficulty focusing/concentrating or feeling like your mind is going blank
6. Increased muscle tension and/or soreness
7. Difficulty falling or staying asleep, or having restless/unsatisfying sleep 

What is Social Anxiety Disorder?

Many of us experience shyness throughout our lives and that can be an informative feeling to explore, address, and overcome. Social Anxiety Disorder involves a little more than common shyness.

When someone has this disorder, they’re often consumed with worries about what other people think about them. They can also experience panic attacks when engaging in social interactions.

Folks with these excessive fears and worry about being judged, embarrassed or humiliated, or about offending others, often avoid social situations. That avoidance can feel like such a relief at first, but it actually strengthens the social anxiety. That feeling of relief reinforces the avoidant behavior, so they’re more likely to continue avoiding social situations.

It can be really difficult, because our social supports keep us healthy. Staying social can stave off depressive (and other mental health) symptoms. And social isolation can contribute to internal distress.

What is Panic Disorder?

Panic is the sudden onset of uncontrollable fear. When you’re diagnosed with Panic Disorder, it might be because you experience these attacks periodically or repeatedly, and often without warning.

Panic attacks are often accompanied by chest pain, rapid or irregular heart rate, dizziness, trouble breathing, and the feeling of knots in the stomach. People who experience panic attacks have often felt as though they were having a heart attack.

This is different from an anxiety attack, which is more classified by worries, muscle tension, irritability/agitation, and difficulty concentrating. Not unlike Generalized Anxiety Disorder, Panic Disorder can be just as debilitating and challenging to manage and can impact social functioning much the same as Social Anxiety Disorder. 

What are Phobias?

A phobia is an intense irrational fear or aversion of something. Most of us have things that activate our senses of fear or discomfort. There is significant overlap between symptoms of Phobias and Panic Disorder but people who experience phobias may not actually experience panic attacks. Here is a list of general symptoms of phobias:

• Pounding/racing heart
• Shortness of breath
• Rapid speech or the inability to speak
• Dry mouth
• Gastrointestinal distress
• Nausea
• Increased blood pressure
• Trembling or shaking
• Tightness in the chest or chest pain
• Dizziness, feeling lightheaded, or disorientation
• Clammy palms/profuse sweating
• Mind racing with thoughts that the worst will happen
• A choking feeling

It’s also important and interesting to note that many “irrational” fears (eg. heights, spiders, enclosed spaces, etc.) have an evolutionary benefit, right? It’s information. Paying attention to physical, emotional, and cognitive processes that contribute to your distress can help remind you of their rationality and regain control.

Examples of common phobias:

• Acrophobia – fear of heights
• Claustrophobia – fear of tight spaces
• Hemophobia – fear of blood or injury
• Arachnophobia – fear of spiders
• Nyctophobia – fear of the dark
• Aviophobia – fear of flying

What is Agoraphobia?

The direct translation of the term “agoraphobia” is a “fear of the marketplace.” It’s a fear of places and situations that you cannot easily escape or get out of.

People who suffer from agoraphobia often have difficulty leaving their homes. They might feel scared of being trapped in a crowd or being unable to get back home.

These worries might even cause panic attacks. And because panic attacks can feel really scary, having one can reinforce social isolation.

What is Obsessive-Compulsive Disorder (OCD)?

Obsessive Compulsive Disorder is an anxiety related disorder where a person suffers from anxiety/distress producing obsessions (intrusive, unwanted, recurring thoughts) and/or a set of compulsions (uncontrollable behaviors that attempt to relieve the distress of the moment) that interfere with their daily lives.

Some common examples of obsessions/compulsions are represented below:

We can all be a bit particular about certain things and have unwanted thoughts going through our mind on occasion.

However, if you:

• Have difficulty controlling your thoughts or behaviors to the point that it’s distressing,
• Spend at least an hour a day on such thoughts/behaviors,
• And experience significant troubles in your day-to-day functioning as a result of these thoughts/compulsions,

Treatment for OCD might be helpful to you.

What is Post Traumatic Stress Disorder (PTSD)?

PTSD isn’t exactly an anxiety disorder. Trauma is “exposure to actual or threatened death, serious injury, or sexual violation.”

The person experiencing the stress reactions had to have directly experienced or witnessed the event, learned about an violent or accidental incident that happened to a close family member or friend, or has been exposed to repeated/extreme aversive accounts and details.

In order for it to be considered a disorder, the disturbed reactions result in marked impairment in a significant area of the person’s functioning (eg. social, professional, academic, family, etc.).

People diagnosed with PTSD often suffer from symptoms in one or more of the following categories:

• Intrusive symptoms (eg. intrusive and distressing thoughts or images, dreams)
• Dissociative reactions (eg. flashbacks in which the individual feels like the event is happening again)
• Avoidance of stimuli connected to the traumatic event
• Significant alterations in mood and cognitions that can result in challenges with emotional regulation and social functioning
• Activated arousal, including irritability, agitation, impulsivity, hypervigilance, disrupted sleep and/or difficulty focusing. 

Resources for Signs and Symptoms of Anxiety

Cognitive Behavioral Therapy (CBT)

Cognitive Behavioral Therapy has two basic premises.

There is the Cognitive Model:

• There is an activating event that triggers a core belief about yourself within the given situation
• That core belief spawns a series of thoughts that contribute to emotions that motivate you to act.

There is also the Behavioral portion of the model (Operant Conditioning):

• Behavior is reinforced by a series of rewards and punishments.
• Behavior is extinguished by a series of rewards and punishments.

Essentially, CBT targets thoughts and behavior patterns to help someone improve their quality of life. CBT was originally developed to treat Major Depressive Disorder. It has been adapted to treat many (if not most) mood related conditions, including anxiety disorders.

Exposure and Response Prevention (ERP)

Exposure and Response Prevention (ERP) is rooted in the behavioral model and application of CBT.

It refers to habituating people to the stimulus/stimuli that result in feelings of anxiety, fear, or panic and changing the outcome response. Habituation involves exposing the person to the fear-inducing stimuli until the fear subsides and then using response prevention to modify the avoidant or ritualistic behaviors by replacing them with more adaptive habits.

ERP is one of the more effective treatments for conditions like OCD even where medication hasn’t helped.

Acceptance and Commitment Therapy (ACT)

Acceptance and Commitment Therapy is considered a behavioral intervention that facilitates “psychological flexibility”.

Psychological flexibility is the ability to stay in contact with the present moment regardless of unpleasant thoughts, feelings, and bodily sensations, while choosing one’s behaviors based on the situation and personal values.

ACT differs from CBT in that, instead of learning to control the distorted thoughts or maladaptive behaviors, ACT focuses on observing, noticing, and accepting the feelings, thoughts, and sensations of the present moment.

According to ACT, the issues that people have in relating can be summed up by the acronym FEAR:

This can be replaced by making choices to ACT:

Acceptance and Commitment Therapy is also an evidence-based intervention indicated for anxiety meaning that there is a strong scientific evidence base for its effectiveness in treating anxiety related disorders.

Medication

Medication can play a role in managing distressing symptoms, depending on your needs. If you’re seeking treatment, medication is an option worth exploring and discussing with your provider. Though it’s not a perfect science, there is a considerable scientific evidence base for using medication to successfully treat anxiety. Its use can, however, come with a number of side effects, which should be a part of the conversation with your physician. 

Anxiety during COVID-19

Even though the pandemic’s severity has fluctuated throughout 2020, it can still feel scary. It can be hard to experience and regulate our feelings right now. Anxiety can be a powerful motivator, but it can also be debilitating.

Let’s remind ourselves that we are going through a global trauma. Our health, lives, and safety is currently challenged and impacted in ways that are unprecedented. The crucial thing to remember is that while our anxiety may be present, so are our treatment options.

New York Behavioral Health providers offer online therapy for individuals, couples, and families, and you can schedule an appointment online today. And remember, we are all just doing the best we can. Let’s give ourselves some compassion and kindness during this time.