Anxiety Disorders
Panic Disorder
One or more panic attacks followed by anticipatory anxiety about having more panic attacks. Some people worry about having a heart attack or going crazy. Some people develop agoraphobia, which is an avoidance of places or situations the person fears may cause a panic attack. If the situation or location cannot be avoided it causes extreme anxiety.
Generalized Anxiety Disorder
Excessive worry about several events or activities to the point that the anxiety interferes with a person’s normal life. It can lead to physical and emotional symptoms, which include: restlessness, easy fatigability, trouble concentrating, irritability, muscle tension and sleep disturbance.
Obsessive-Compulsive Disorder
Either obsessions or compulsions or both.
Obsessions — Persistent intrusive thoughts, impulses or images that cause anxiety or distress. There is a recognition that these are the product of the person’s own mind, and the person tries to ignore, suppress or neutralize them with another thought or action.
Compulsions — Repetitive behaviors or mental acts the person feels driven to perform in response to an obsession (i.e. hand washing, ordering, checking, praying, counting, silently repeating words, etc.) The behaviors may follow specific self-imposed rules and are aimed at preventing some dreaded event or situation. They are done as an attempt to reduce distress, which may be successful but only for a very short period of time.
Social Phobia
Fearfulness of social or performance situations in which the person is exposed to unfamiliar people or to scrutiny by others. The person fears she will be embarrassed or humiliated by her behavior. It may be a generalized anxiety that is associated with most social situations or it may only occur in limited situations. Some examples include: public speaking (most common), conversations in small groups or even with individuals, dating, attending parties, eating in public, using public restrooms.
Posttraumatic Stress Disorder (PTSD)
A person experiences or witnesses a traumatic event (maybe a repeated trauma as with abuse), which causes intense fear, horror or helplessness, and the event is relived repeatedly. The person may experience intrusive memories or dreams of the event or may feel as if the event is recurring (flashbacks). The person tries to avoid anything that may remind her of the event and may find herself becoming numb in personal relationships. In addition the person may be “wound up” and have trouble sleeping, concentrating and controlling anger or irritability. She may startle easily and be hypervigilant. Symptoms may begin immediately after the trauma or many years later (sometimes seen with childhood abuse).
One or more panic attacks followed by anticipatory anxiety about having more panic attacks. Some people worry about having a heart attack or going crazy. Some people develop agoraphobia, which is an avoidance of places or situations the person fears may cause a panic attack. If the situation or location cannot be avoided it causes extreme anxiety.
Generalized Anxiety Disorder
Excessive worry about several events or activities to the point that the anxiety interferes with a person’s normal life. It can lead to physical and emotional symptoms, which include: restlessness, easy fatigability, trouble concentrating, irritability, muscle tension and sleep disturbance.
Obsessive-Compulsive Disorder
Either obsessions or compulsions or both.
Obsessions — Persistent intrusive thoughts, impulses or images that cause anxiety or distress. There is a recognition that these are the product of the person’s own mind, and the person tries to ignore, suppress or neutralize them with another thought or action.
Compulsions — Repetitive behaviors or mental acts the person feels driven to perform in response to an obsession (i.e. hand washing, ordering, checking, praying, counting, silently repeating words, etc.) The behaviors may follow specific self-imposed rules and are aimed at preventing some dreaded event or situation. They are done as an attempt to reduce distress, which may be successful but only for a very short period of time.
Social Phobia
Fearfulness of social or performance situations in which the person is exposed to unfamiliar people or to scrutiny by others. The person fears she will be embarrassed or humiliated by her behavior. It may be a generalized anxiety that is associated with most social situations or it may only occur in limited situations. Some examples include: public speaking (most common), conversations in small groups or even with individuals, dating, attending parties, eating in public, using public restrooms.
Posttraumatic Stress Disorder (PTSD)
A person experiences or witnesses a traumatic event (maybe a repeated trauma as with abuse), which causes intense fear, horror or helplessness, and the event is relived repeatedly. The person may experience intrusive memories or dreams of the event or may feel as if the event is recurring (flashbacks). The person tries to avoid anything that may remind her of the event and may find herself becoming numb in personal relationships. In addition the person may be “wound up” and have trouble sleeping, concentrating and controlling anger or irritability. She may startle easily and be hypervigilant. Symptoms may begin immediately after the trauma or many years later (sometimes seen with childhood abuse).
Treatments for Anxiety Disorders
Treatment for Panic Disorder
Goal — Control panic attacks ASAP followed by control of anticipatory anxiety. Teach skills to manage future anxiety to keep it at a normal level and prevent it from getting out of hand.
Steps
Treatment for Generalized Anxiety Disorder
Goals — Bring the intensity and frequency of anxiety into a normal range.
Steps
Treatment for Obsessive-Compulsive Disorder
Goals — Diminish obsessions to a manageable range and control the manifestation of compulsions by controlling the anxiety that drives them.
Steps
Treatment for Social Phobia
Goal — Diminish anxiety in social situations so that the person can function at a normal level in their life.
Steps
Treatment for Posttraumatic Stress Disorder
Goal — Manage the anxiety associated with memories of the event and return to normal functioning in general so that past experiences no longer impair current emotional state.
Steps
Goal — Control panic attacks ASAP followed by control of anticipatory anxiety. Teach skills to manage future anxiety to keep it at a normal level and prevent it from getting out of hand.
Steps
- Medications:
• Benzodiazepines (if no history of substance abuse) to gain rapid symptom control. (This is a band aid approach to help contain anxiety until more preventative medication can become effective.)
• SSRI’s or SNRI’s (also known as the newer antidepressants) started at very low doses and gradually titrated up to an effective range to prevent panic attacks and tone down anticipatory anxiety. These medications will work to control anxiety even if depression is not present. - Education about physiology to remove the fear of various bodily sensations.
- Teach cognitive skills (new ways of thinking) to lead to different (calmer) emotions.
Treatment for Generalized Anxiety Disorder
Goals — Bring the intensity and frequency of anxiety into a normal range.
Steps
- Medications:
• Benzodiazepines (if no history of substance abuse) to gain rapid symptom control. (This is a band aid approach to help contain anxiety until more preventative medication can become effective.)
• SSRI’s or SNRI’s (also known as the newer antidepressants) started at low doses and gradually increased to a point where anxiety levels fall to a relatively normal level. - Teach how to distinguish between normal and abnormal anxiety and how to manage both kinds of anxiety as they occur. This is done by teaching cognitive (thinking) skills so the person can learn new ways of looking at and dealing with situations and thus feel less anxious. Behavioral skills are also taught to help manage physical symptoms when they occur and prevent them in many cases.
- Teach how to use these skills when future episodes begin so the episode can be caught early and nipped in the bud.
Treatment for Obsessive-Compulsive Disorder
Goals — Diminish obsessions to a manageable range and control the manifestation of compulsions by controlling the anxiety that drives them.
Steps
- Medications (not necessarily first line of treatment):
• SSRI’s started at an average dose and adjusted up to control obsessive thinking as well as to give the person control over compulsions
• Benzodiazepines to be used on an as needed basis (sparingly) - Teach cognitive (thinking) skills to manage obsessions.
- Exposure-Response Prevention (ERP) therapy to help the person become desentisized to the anxiety brought on by not following through with a compulsion.
- Treat any depression that may accompany OCD and repair social and occupational damage that has likely occurred over time.
Treatment for Social Phobia
Goal — Diminish anxiety in social situations so that the person can function at a normal level in their life.
Steps
- Medications (used sometimes but not usually first line):
• Benzodiazepines (minor tranquilizers) as needed in social situations while the person is learning skills to deal with the issues more definitively
• SSRI’s if symptoms are severe or persistent after learning and using skills taught in therapy - Teach specific social skills that may be weak or lacking
- Teach anxiety management skills so that the person becomes comfortable with using them in general situations before testing them in social situations.
- Exposure to social situations in gradually increasing levels of difficulty after adequate emotional tools have been attained.
Treatment for Posttraumatic Stress Disorder
Goal — Manage the anxiety associated with memories of the event and return to normal functioning in general so that past experiences no longer impair current emotional state.
Steps
- Retell the details of the event to take away some of the intense emotions associated with it.
- Help the woman make as much sense of the situation as possible.
- Teach basic behavioral anxiety management skills.
- Uncouple triggers (i.e. sights, sounds/words, smells, locations, etc.) from current day situations to prevent overreactions and going into panic mode.
- Practice re-exposure to triggers (i.e. drive by intersection where auto accident occurred) until it can be done with manageable anxiety levels while using tools previously learned.
- Help the woman reorganize her view of the world in a healthy manner by integrating her traumatic experience into a new approach to life.