Understanding And Dealing With Anxiety

By: Michael G. Conner, Psy.D

Revised: May 21, 2014

Anxiety disorders are very common psychiatric conditions and are very responsive to treatment. At one time or another everyone has experienced anxiety or fear. Anxiety and fear are the same emotional condition, but they can be experienced in different waysThe feeling of anxiety is generally characterized as diffuse, unpleasant, a sense of apprehension or worry, and has physical symptoms that may include headache, muscle tension, perspiration, restlessness, tension in the chest and mild stomach discomfort. Anxiety can produce confusion, memory problems, as well as distortions of reality and the meaning of events. Anxiety becomes a disorder when the symptoms are severe, pervasive, lasting and interfere with normal life. Panic disorder is another common psychiatric condition.  Panic is a spontaneous, unexpected, recurrent, intense and overwhelming form of anxiety. The feeling of panic is characterized as extremely unpleasant, a feeling of fear or dread, and may include symptoms of rapid heart beat, chest tension or pain, impaired breathing, dizziness and tingling sensations, etc… Anxiety disorders can develop gradually over long periods of time or very quickly. These disorders can become disabling and interfere with school, relationships, social activities and work.

There is reason to be concerned if the symptoms of anxiety or panic are severe, prolonged, unexpected, seem unusual or have no apparent cause. Recognizing the symptoms of anxiety and panic can help you deal with these conditions and seek help from a qualified mental health professional.

Symptoms Of Anxiety

  • Experience of fear

  • Restlessness

  • Irritability

  • Avoidance

  • Rapid labored breathing

  • Sweating or perspiring

  • Trembling or "shaking"

  • Weakness

  • Problems concentrating

  • Poor memory

  • Neglecting responsibilities

  • Thoughts of danger

  • Increased energy

  • Frustration

  • Impatience

  • Rapid heart beat

  • Chest pain or tension

  • Muscle tension

  • Indigestion or diarrhea

  • Dizziness or feeling "light-headed"

  • Racing thoughts

  • Dwelling on fearful possibilities

  • Problems performing tasks

  • Frightening images

Serious And Critical Symptoms

  • Chest pain

  • Weakness or paralysis

  • Dizziness, fainting or passing out

How Symptoms are Reinforced

Once a fear or anxiety response has been elicited, the response tendency can be maintained in a number of ways.  A few of these are:

  • Self-talk or "automatic" thoughts (e.g. I can't handle new situations. All dogs want to bite me.)
  • Avoidant behavior (e.g. A child steps on a dogs tail and is bitten by the dog. The child is then afraid of all dogs and avoids them. The child avoids talking about their fear.)
  • Inappropriate response to fearful child (e.g. The child’s parents begin to ridicule him for feeling afraid instead of rewarding the child’s effort and courage.)

Symptoms and Behaviors Associated With Anxiety

  • Excessive or unreasonable fears
  • Recurrent memories and feelings about a traumatic event
  • Persistent avoidance of a feared situation, object or situation associated with a previous trauma
  • Physiological reactivity associated with feared situations, objects or previous trauma
  • Recurrent or persistent ideas, thoughts, impulses or images that are initially experienced as intrusive or senseless
  • Repetitive, purposeful and intentional behavior designed to minimize discomfort or prevent some feared event. The behavior is excessive or not connected to the situation or feared object.

There Are Roughly 11 Diagnostic Categories Associated With Anxiety Disorders.

  • Separation Anxiety Disorder. Anxiety is the result of separation from a significant figure or person (usually a parent).
  • Avoidant Disorder. The feared situation is social contact with others.
  • Overanxious Disorder. Persistent anxiety which is not linked to an identifiable situation.
  • Generalized Anxiety Disorder. Unrealistic or excessive anxiety or worry about two or more life circumstances.
  • Agoraphobia Without History Of Panic Disorder. Fear and anxiety associated with being alone or in a public place from which escape or aid might be difficult.
  • Panic Disorder. Unexpected and immediate episodes of intense fear which are not linked to any specific situation.
  • Panic Disorder with Agoraphobia. Same as a panic disorder but also an intense fear of situations in which escape or aid might be difficult. 
  • Obsessive Compulsive Disorder. Anxiety is related to recurrent obsessive thoughts, images, or impulses. Symptoms may also be tied to compulsive behavior in the form of regimented, rigid or useless behavior that is excessive or unreasonable.
  • Post-Traumatic Stress Disorder. Anxiety is related to a catastrophic event and is repeatedly relived symbolically through play, dreams, or flashbacks.
  • Social Phobia. Fear associated with being scrutinized by others or appearing foolish.
  • Simple Phobia.  A fear/anxiety response to any object or situation not mentioned in any of the other diagnostic categories.

There is a tremendous amount of research regarding the biological and psychological basis of anxiety disorders. Anxiety disorders occur in 10 to 15 percent of the population. Panic disorder occurs in approximately 2 to 4 percent of the population. Approximately one half of all patients with panic disorder have an immediate blood relative with panic disorder. Studies of identical twins have shown that panic disorder may occur with one twin but not the other. Most people experience an anxiety disorder purely on the basis of psychological, social and environmental influences. Anxiety disorders are not necessarily inherited although some people appear to inherit a risk or vulnerability for an anxiety disorder from family. Brain imaging studies have produced minimal data to suggest there is a single defect or problem in the brain that causes or contributes to anxiety.

Dealing with symptoms of anxiety and panic requires an understanding as to whether the symptoms are a normal reaction, the result of a psychological disorder, or the result of a medical problem or condition. There are a number of medical problems and conditions that can look and feel like anxiety and panic.  Anxiety disorders are usually the result of a psychological disorder or a medical condition when they are severe, interfere with our ability to function or are prolonged. Approximately 50% of all cases involving symptoms of panic disorder are actually caused or triggered by an unrecognized and untreated medical problem.

Common Treatment Approaches

A large number of treatment strategies have been developed for the treatment of anxiety related disorders. Some of these are:

  • Prolonged Exposure. The patient is encouraged to confront the feared situation or object using real or imagined versions in conjunction with other supportive aids such as relaxation, hypnosis or biofeedback.
  • Modeling. Patients observe another person interacting with the feared situation or object. Adaptive responding is demonstrated with guided instruction, support, and feedback.
  • Contingency Management. External events that follow the patient's fear/anxiety reactions are manipulated using rewards for successful interaction and bolder steps. Rewards are rescinded for refusing to interact.
  • Self-Management. Subjective and physiological reactions are altered or changed by teaching a patient adaptive ways of appraising an upcoming situation, adaptive ways of thinking, and deep muscle relaxation techniques.

There are numerous anti-anxiety medications that are routinely used with adults. Benzodiazapenes are the largest class of these drugs and are referred to as sedative-hypnotics. Sedative-tranquilizers are used in some cases but less frequently. Each of these drug categories are moderately to highly addictive and are effective in reducing or eliminating symptoms. They do not cure the disorder. While there a number of medications available for anxiety disorders, their side effects limit their use.

In general, anxiety disorders are very responsive to psychotherapy. Panic disorder is one of the most responsive. Effective therapy must include evaluation of the patient's entire biological, psychological, social and cultural background.  Medications can be helpful, but the side effects of these medications and the potential for addiction with some medications must be considered. Psychotherapy can be a very effective alternative to the use of medications. In most cases, there must be changes in the patient’s environment and social support system for treatment to be successful. Families of people with anxiety disorders can fail to see how they reinforce the disorder. Families are often resistant to change despite expressed dedication of support and a desire to do whatever is necessary. Embarrassing or punishing an anxious person will only make the disorder worse. There are effective and ineffective therapies. While some professionals prefer to emphasize that psychotherapy is effective, it is worth recognizing that effective therapies can be used incorrectly by well intended therapists. Competence, commitment as well as outstanding interpersonal qualities in a therapist are crucial for treatment to be successful.

Psychotherapy requires significant commitment of time while treatment of anxiety and panic disorders with medication requires less effort. Since normal anxiety can improve over time without therapy, a brief period of medication can relieve symptoms, restore functioning and not necessarily require long term or life long reliance on medication.   Use of medication in some cases can result in a dependence on that medication to manage anxiety. Psychotherapy is almost always the first treatment of choice except in cases where anxiety or panic is so severe that immediate relief is necessary to restore functioning and to prevent immediate and severe consequences. Medication is usually the second choice after a comprehensive and competent trial of psychotherapy. Combined use of medications and psychotherapy at the onset of treatment can confuse an evaluation of treatment effectiveness. It is harder in a combined medication and therapy approach to tell which approach is or is not helping and how much it is helping.

Psychotherapy, or the psychotherapist, can generally be considered ineffective if a trial of 3 months has not produced a measurable and noticeable improvement. A decision to change therapists or to start a medication may be necessary at this point. Several trials of psychotherapy or medications may be necessary to successfully treat anxiety or panic disorders.

Information And Steps You Can Take

  • Seek immediate advice and consultation from a qualified health care professional if you have any of the serious and critical symptoms
  • Seek advice and consultation from a qualified mental health professional if you experience symptoms of anxiety and panic that are either recurrent, severe, debilitating, seem unusual or unrelated to an existing health problem.
  • Seek medical advice if you have health problems or you have not had a medical evaluation for your symptoms.
  • Recognize the biological effects of alcohol. Alcohol is a depressant in which prolonged or excessive use will increase and deepen symptoms associated with anxiety. Withdrawal from alcohol and certain drugs can produce symptoms of anxiety and panic.
  • Avoid drugs that are not medically appropriate or approved by your physician. Some symptoms of anxiety and panic are associated with certain medications.
  • When anxious or panicked, remember to breath fully and calmly and at a normal regular intervals. An occasional slow deep breath can help you relax and can prevent symptoms of panic. Avoid rapid short breaths.
  • Maintain regular physical activity. Physical activity can be an effective way to relieve symptoms and build strength to resist stress.
  • Don't fight your symptoms of anxiety by trying to wish the feelings away. Will power is not a solution.
  • Do not focus or dwell on how it might get worse. Negative predictions can result in panic.
  • It can help to focus on and do simple, fun, interesting and safe manageable activities or tasks.
  • Notice when you eventually stop thinking frightening thoughts your symptoms tend to fade in time.
  • Humor and laughter are good best ways to reduce and prevent symptoms of anxiety and panic.
  • Notice if there is a relationship between what you are doing and your symptoms. This can help during an evaluation and in treatment of these disorders.

copyright 1998 to 2008, Michael G. Conner