Stress can cause serious changes in our level of physical, mental, emotional, and spiritual health. Anxiety disorders are a group of mental disorders brought about by stress. When stressors persist, they can cause anxiety.
One of the instantaneous reactions to sudden stressors is an increase in mental activity. Our brains are programmed with the capacity to make split-second life-or-death decisions when we are stressed. Long after the stressor is gone, however, it can persist in our minds. For example, a traumatic life experience such as rape, war, or natural disaster can remain a mental stressor for years after the event transpired. When stressors persist—on any level—they can cause anxiety. To put anxiety in perspective, some important facts are laid out in Figure 1.
Regarding the first fact in Figure 1, it is important to note that not all stressors are sufficient to cause an anxiety disorder, even if they are perpetuated. But for those who have a genetic predisposition to such a condition, long-term unresolved stress may provide fertile soil in which an anxiety disorder can germinate.
Is anxiety an illness?
Anxiety disorders are truly illnesses. They are the most common of all mental disorders, and they vary widely in severity. On one hand, there may be frequent feelings of anxiety with relatively little apparent disruption in the person's life. At the other extreme, bouts of profound anxiety can occur that terrify and immobilize the sufferer.
This is not an exhaustive study on these disorders, but certain information deserves our attention. Note that these disorders are treatable. Anxiety disorders often go undiagnosed and then treated for years. This is tragic because prescription drug-therapies and non-medication strategies can be extremely successful, such as in our Depression & Anxiety Recovery Programs.
Is an anxiety self-diagnosis good enough?
Note also that self-diagnosis of these kinds of disorders may not be effective. Many individuals may misdiagnose themselves as merely “dealing with stress poorly” when in reality they may have a much more serious problem. Anxiety disorders are bona fide psychiatric conditions. They are best addressed by working with a qualified health professional.
An unfortunate feature of anxiety disorders is the company that they keep. About half of those who have a generalized anxiety disorder also have either a second anxiety disorder or depression. An awareness of a possible second disorder may help one look for indications of its presence.
Fortunately, there are several insights regarding the treatment of anxiety. I will share a number of these insights to provide a better understanding of treatment options and underlying causes.
How can I recognize an anxiety disorder?
There are five main forms of anxiety disorders. A brief overview is provided in Figure 2. Despite these identifying characteristics, people with anxiety disorders typically do not appear to the untrained eye to have major psychiatric problems. For example, an individual with a generalized anxiety disorder may appear to be simply a worrywart. Often the individual is totally oblivious to the fact that he has a diagnosable psychiatric condition that can be treated. Let us look more closely at each of the five forms of anxiety disorders listed in Figure 1.
1. Generalized Anxiety Disorder
Generalized Anxiety Disorder, GAD, usually does not cause significant impairment. Affected individuals typically function quite well in society. The good news about this condition is that most people tend to grow out of it. Typically, symptoms seem to become less severe with age. However, debilitating cases of GAD can occur. Medication therapy and non-drug therapy may each be of help. Buspirone (BuSpar), a prescription drug, may provide some help. However, five non-drug therapies have also proven effective. They are called cognitive behavioral therapy (CBT), regular physical exercise, biofeedback, relaxation techniques, and spiritual focus therapy. You can read about the last four treatments in chapter six of my book Depression the Way Out.
Caution should be used in taking drug therapy. There are at least three reasons why it may be a mistake to take this seemingly easiest route. First, it can take up to several weeks before buspirone produces any benefit. Second, it can cause a number of disconcerting side effects including dizziness, drowsiness, and nausea. Third, there are concerns about worsening of GAD when the drug is stopped. Many patients are generally not interested in a lifetime of medication if other strategies can address their problems.
Other brain chemicals play a role in anxiety pathways. Two critical ones are serotonin and GABA. Both compounds are called inhibitory transmitters. They can dampen brain pathways that are involved in stress and anxiety. Further reinforcing the accuracy of these connections are several medications that can boost serotonin levels. In many cases these drugs not only can alleviate depression but can also help ease the effects of anxiety disorders. Fortunately, we are not dependent on medications only to boost our levels of this vital brain chemical. Read more in chapter 4 of Depression the Way Out to learn how you can boost serotonin naturally.
2. Panic Disorder
Panic disorder is a condition wherein individuals experience what is called a panic attack. They feel like they are losing control or going crazy and may have strong feelings of impending doom. Physical symptoms of panic disorder include pounding heart, chest pain, sweating, lightheadedness or dizziness, trembling or quivering, nausea or other stomach problems, shortness of breath, or numbness or tingling.
Panic attacks are not limited to those who have panic disorder. Such attacks occasionally occur in people who are free of mental illness. They also commonly accompany other psychiatric conditions such as social phobia, generalized anxiety disorder, and major depression.
What's the criteria for panic disorder diagnosis?
To be diagnosed with panic disorder, a person must have had at least two unexpected panic attacks and either be worried about future attacks or take precautions to avoid the same. In those with the disorder, the severe anxiety between attacks can result in a full-blown phobia. For example, if someone had a panic attack while riding the train, they end may develop a fear of trains. Studies suggest that people with panic disorder have a lowered threshold for activating their mechanisms for combating stress.
Affected individuals tend to subconsciously perceive non-threatening situations as dangerous, and thus their stress systems become activated. Effective non-drug treatment regimens utilize CBT, as seen in Figure 3.
The decision whether or not to seek treatment should not be taken lightly. Untreated panic disorder has been demonstrated to significantly increase the risk of suicide. SSRI medications are often effective in treating it. I use benzodiazepines such as Xanax short term (for less than 30 days) to help severe life-threatening panic disorder until the SSRI medication and lifestyle therapies have had a chance to work. It is very important for panic disorder patients to recognize that they are not actually having a heart attack and that their severe symptoms will soon pass without having to visit the emergency room. Such reassurance itself can be therapeutic.
3. Post-Traumatic Stress Disorder
Post-Traumatic Stress Disorder (PTSD) typically occurs in individuals who have lived through a severe, emotionally traumatic experience. PTSD can be debilitating and may interfere with close personal relationships. PTSD can result in a myriad of reactions such as nightmares, sleeping problems, daytime fears, depression, withdrawal, inability to trust others, emotional numbing, and feelings of helplessness. The victim also tends to avoid situations that trigger uncomfortable memories.
In addition to PTSD among veterans, this condition now afflicts more than eight million Americans each year and results from any of a variety of traumatic events. [i] These can include experiencing (or seeing others traumatized by) rape or sexual abuse, other criminal victimization, natural disasters such as hurricanes or earthquakes, and serious car wrecks.
PTSD is not an inevitable result of severe stressors. Even among those exposed to extreme trauma only about 9 percent develop PTSD. The fact that not all traumatized individuals developed PTSD underscores one of the most important aspects of stress theory. Genetic factors, personal coping styles, and other social factors all seem to have an impact on whether or not PTSD develops. There is evidence suggesting that a person who receives strong social support following a traumatic event is less likely to develop PTSD.[ii]
“CBT typically forms an important part of the treatment.”
Even when individuals develop PTSD, they often do not have all the characteristics of the disorder, and the length and extent of the recovery is also variable. Approximately 50 percent of affected individuals recover fully within six months. On the other extreme, some patients are dogged by the condition for decades or even the rest of their lives.
How is PTSD treated?
The options for treatment depend on the nature of the problems associated with any given case of PTSD. If depression and sleeping difficulties are present, antidepressants, and/or anxiety-reducing medications may be prescribed. PTSD is another anxiety disorder where CBT typically forms an important part of the treatment. Strong social support such as building better ties to family, friends, and the community may also help ease PTSD symptoms.
There is significant variability in PTSD and its related symptoms from one afflicted person to another. However, treatment can result in rapid improvement of the condition. One of the greatest tragedies with a treatable anxiety disorder like PTSD is a lengthy time delay before patients seek treatment. The average delay is 8 years. [iii]
Phobias are characterized by extreme, irrational fear. Specific phobias, such as fear of spiders, are common, striking more than one in 10 people. Depending on how easy it is to avoid the source of the phobia, the disorder may or may not be particularly debilitating. However, if the object that they feared is frequently encountered, affected individuals may seriously alter their lives in an attempt to deal with their condition. Further complicating phobias is the fact that only about 20% of adult phobias are resolved without treatment. Specific phobias generally do not result from exposure to a single stressful event. More typically, the stressor is an attitude communicated by other family members or close friends.
What is social phobia?
Social phobias are characterized by being inappropriately afraid or uncomfortable in specific social situations. These phobias can be markedly intensified by an experience of public embarrassment or some other stressful experience in public. Fortunately, effective treatments exist for phobias. Treatments are described in Figure 4.
Once phobias are diagnosed, specific cognitive behavioral therapy techniques may be helpful. One technique exposes the patient to the phobic situation in small incremental steps. Non-drug CBT either alone or with additional medications (such as anti-depressants or anti-anxiety drugs) can completely prevent panic attacks and 70 to 90% of sufferers. [iii] CBT and related therapies typically bring significant improvement within eight weeks.
No medications have emerged for treating specific phobias. However, when it comes to social phobias, some medications have proven effective, including antidepressants called MAO inhibitors. Beta blockers have helped a specific form of social phobia called performance phobia.
Another application of CBT is the use of breathing exercises. Proper or diaphragmatic breathing focuses on slow, deep breaths that rely on the diaphragm. Such breaths can combat a common relative of anxiety—taking rapid, shallow breaths. About 75% of patients improve significantly with CBT approaches.
5. Obsessive-Compulsive Disorder
OCD is a disorder with two obvious characteristics—obsessions and compulsions. A classic example would be inordinate fear of germs, which is addressed by repeated meticulous hand washing that far exceeds any normal health concern. Fear of germs is the obsession and the repetitive hand washing is the compulsion. The disturbing obsession is perceived as a problem that must be fixed, and it results in a compulsive attempt to resolve it. We're not talking about normal concerns for hygiene or safety. If the activities associated with the disorder consume at least an hour a day and are very distressing to the point of interfering with daily life, it qualifies as a case of OCD.
The classic behavioral therapy for OCD is called exposure and response prevention. In this treatment, the OCD sufferer is exposed to a situation that is the focus of the obsession and then is assisted in avoiding the usual ritual. Drugs that boost brain serotonin levels helped 75 to 80% of patients dramatically. However, at least the same amount of improvement is found in non-drug behavioral treatments. Learn more about serotonin here.
It is no surprise that several “standard” therapies for anxiety disorders involve medications. Nonetheless, I want to re-emphasize one of my themes—that lifestyle therapies can often have profound effects on brain chemistry. The value of non-drug cognitive behavioral therapy in many of the anxiety disorders testifies to the fact that there are options for treatment in the mental health arena besides drug regimens.
I recommend to those inclined to utilize lifestyle therapies for anxiety disorders to work with qualified health practitioners to carefully monitor their progress. If you are on medication for anxiety disorder, do not stop it abruptly. Even if you no longer need medication, drugs affecting brain chemistry should be gradually decreased in dosage. And that process should be conducted with expert professional advice. I recommend a competent medical practitioner who would include lifestyle therapies as a part your treatment program. You can learn more about lifestyle interventions for combatting depression and anxiety on the Let’s Talk Mental Health blog, or at www.nedleyhealth.com, such as our articles on how to reduce stress and how to practice CBT.
Neil Nedley, MD, is a practicing physician in internal medicine. He is the founder and medical director of the Nedley Depression and Anxiety Recovery Programs™. Dr. Nedley has presented and published numerous scientific studies in the medical literature and is well known internationally as a public speaker and teacher. He is author of Proof Positive, Depression—the Way Out, The Lost Art of Thinking, and Optimize Your Brain. Dr. Nedley and his wife Erica have four sons.