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We have all experienced significant anxiety at one time or another, although perhaps not severe enough to warrant a diagnosis by a professional. Anxiety is a danger or an alert signal. The physiological arousal we experience as anxiety is directly related to fear of harm. When we are faced with a threat to our physical well-being that can result in either serious physical harm or death, we respond psychologically and physically. This response has been called the "fight or flight" response because it activates us to either defend ourselves, or to run away and escape injury. In a life threatening crisis, this fight or flight response can save our lives.

In our civilized world, we don't encounter genuine threats to our physical safety everyday (unless you count driving in rush hour traffic). Instead, we are faced with problems that complicate our lives. These problems do pose a threat, but usually it is not a physical threat. We may be faced with losing a job, or having our marriage break-up, or maybe our children might fail in school. These may be threats to our well-being, but have more of a psychological impact, than a physical impact. These psychological threats trigger a mild version of the fight or flight response, that we call anxiety. (Except in a panic disorder, when the response is very immediate and severe). Anxiety alerts us to a problem, and motivates us to try to resolve the problem, because we want the anxiety to go away. If we never felt anxious about anything, we would have little motivation to respond to problems, until we were faced with a genuine crisis. Normal anxiety is not a sign of a psychological disturbance, because we all experience it, and it helps us manage out lives by alerting us to problems requiring a response. Anxiety disorders develop when we experience severe anxiety in response to minor or common problems, or when the anxiety never goes away, and actually interferes with our problem solving.

Anxiety problems are very common. In fact, in the United States, more people visit their physician for anxiety than for coughs and colds. The prevalence of anxiety disorders varies by type, ranging from 1% of the population for some disorders, to as high as 58% of combat veterans experiencing post traumatic stress to some degree. The use of medications for anxiety management is very common, but not effective without psychotherapy. In fact, many anti-anxiety medications produce dependency, and the withdrawal symptoms are often similar to anxiety symptoms. These medications control the symptoms without eliminating the cause for the problem. Psychological treatment focuses on reducing the inappropriate anxiety response, so medication is not necessary.

You may link to information about the following anxiety disorders:

Panic disorder

Panic disorder is an anxiety disorder in which repeated panic attacks occur which are unexpected, and not a result of a substance, or another psychological disorder (such as social phobia). Panic disorder can occur with or without agoraphobia being present.

A panic attack is an episode of extreme anxiety that includes a specific pattern of symptoms associated with extreme physiological arousal. There may be heart palpitations, trembling or shaking. Often, there are chest pains which cause the person to believe he/she is experiencing a heart attack. The person may feel dizzy, may sweat profusely, have hot flashes, or experience numbness in the extremities. The person may also experience shortness of breath. Nausea is often present, and sometimes the person has difficulty swallowing or feels like he/she is choking. There may be a feeling of unreality, or being detached from oneself. A panic attack often results in a fear of dying, losing control or going crazy. This attack comes on suddenly, and often occurs without a trigger.

A person with panic disorder spends a tremendous amount of time worrying about having another attack. This may result in lifestyle changes, or other behavior pattern designed to prepare for the possibility of another panic attack. Panic attacks can frequently result in a significant disruption of normal behavior. Many individuals after having a panic attack visit the emergency room of a hospital, because they are convinced that they are having a medical emergency.

Treatment for panic disorder, and the associated anxiety and avoidance behavior, involves psychotherapy, desensitization and other cognitive and behavioral techniques. The goal is to be able to regain control and interrupt a panic attack if one occurs. Frequently, other anxiety issues have to be treated as part of controlling panic disorder.

Post Traumatic Stress Disorder

The essential element of PTSD, is that a person either experienced or observed an event which involved actual or threatened death or serious injury to self or someone else. Within a family, PTSD can develop in response to learning about the violent death of a loved one.

This disorder was first described in Vietnam War veterans, but has also been called "battle fatigue" and "war neurosis" in past wars. More than 50 percent of combat veterans may experience some form of PTSD, although the milder forms may not be diagnosed or treated. Combat veterans tend to experience more severe forms of PTSD because the duration and severity of trauma during war is greater, but the disorder is frequently diagnosed in civilians who have experienced and survived serious trauma. For example, the victims of serious accidents, rape survivors, people burned out of their homes, survivors of other natural disasters such as tornadoes, hurricanes and earthquakes, and violent crime victims all may develop PTSD. In each of these events, the threat of death or serious injury is present, and those who develop PTSD realized, or believed, that their lives were on the line.

Another characteristic of PTSD is the remembering of the trauma, and sometimes actually reliving the events in your mind. Survivors have recurrent recollections of the event, distressing dreams about what happened, or some other form of psychological rehashing of the event. (For example, the survivor of a head-on car crash may sometimes "see" another car coming toward him/her, even though there is no other car.) These violent recollections can have a serious impact on a person's life. As a result, the person avoids all situations that might be a reminder of the trauma, and tends to react with significant anxiety whenever there is a reminder of the event.

People with PTSD may experience a variety of somatic and psychological complaints, including sleep disturbance, outbursts of anger, or an exaggerated startle response. (They jump at sudden noises or movements). Social relationships often suffer, as the person becomes more withdrawn and detached. If you have experienced a serious trauma, and have some of these symptoms, you may want to consult with a psychologist about your condition to determine if you have PTSD, and to learn what can be done to help you.

Treatment is available for PTSD, including the more severe forms seen in combat veterans. A combination of cognitive therapy to alter the recollections of the trauma, supportive counseling while expressing the feelings associated with the events, and behavioral interventions to control the stress responses appears to be most effective. In more severe cases of PTSD, your physician may prescribe medication to be used in addition to the psychological treatment, but medication alone will not reslve these problems.

Social Anxiety

Social anxiety is also called a social phobia. An individual with this problem has persistent fear of social situations, and is fearful of embarrassment. Certain social situations provoke more anxiety than others, and individuals with this problem may sometimes develop a panic attack in response to some specific social event. (e.g. giving a speech). People with social anxiety realize that their fear is exaggerated, but they still cannot control it. They tend to avoid situations in which they need to perform in front of others, and this tends to interfere with life adjustment in some way.

As many as 10 percent of the population may experience social anxiety to some degree, although they all do not seek treatment. Many people are fearful of public speaking, but manage to avoid it and cope well within a slightly more limited life sphere. Some individuals have more severe social anxiety, and are even fearful of talking to strangers in any capacity. These people have more serious adjustment problems, and are more likely to seek treatment. Social anxiety tends to develop during teen years, but often in children described as excessively shy.

Psychological treatment for social phobia uses techniques appropriate to the presenting symptoms. This depends on what triggers the anxiety, whether the individual has panic attacks, and the severity of the symptoms. Most often a combination of behavioral interventions is used with cognitive therapy. The behavioral treatment may include relaxation training and systematic desensitization, as well as immersion therapy. Cognitive therapy helps you to develop cognitive blocking mechanisms when the anxiety begins to build, and also helps you understand why the the social anxiety symptoms occur. This allows you to develop different ways of coping with the anxiety.

Generalized Anxiety disorder

This disorder exemplifies the definition of chronic anxiety, with excessive worrying about a lot of different life events over a period of at least six months. You might feel restless, tense and tired, have difficulty sleeping, find it hard to concentrate, and be more irritable than usual. Many people with generalized anxiety disorder (GAD) describe themselves as chronic worriers, who often become more upset by problems than the average person. The key component of this disorder is not worry, but excessive worry.

Many people with generalized anxiety experience panic attacks at some point in their lives, in response to more severe stress. Eventually, you might begin to worry about worrying. That is, because you see yourself as an anxious person who can't handle stress very well, you develop additional anticipatory anxiety when you must face a stressful situation. (eg. going for a job interview, entering the hospital for a medical procedure, etc.)

Many primary care physicians treat generalized anxiety disorder exclusively by prescribing anti-anxiety medications, especially the benzodiazepines, rather than referring the person for psychotherapy. However, these drugs are not without risk. They cause impairment of cognitive functioning, including reaction time. Many individuals experience rebound anxiety if they abruptly stop taking the medications. Research has also suggested that the benzodiazepines may produce functional changes in the central nervous system that make it difficult for people to withdraw from these drugs.

Generalized anxiety disorder is not a biological problem, it is a psychological problem with pronounced physical symptoms. It requires psychological treatment, most often a combination of behavioral and cognitive therapy. Psychologists have used behavioral treatment effectively to teach individuals how to reduce their anxiety through relaxation exercises. Cognitive therapy techniques help identify and change the expectations you might have that triggers anxiety. A combination of cognitive and behavioral interventions has shown very positive results, without the drawbacks of medication. The development of cognitive coping strategies for managing anxiety is a particularly effective treatment for individuals with generalized anxiety disorder.


Agoraphobia produces intense anxiety when you are in a place where escape is difficult or embarassing. Those people who have had panic attacks often worry about being in a place where help may not be available, if they have another attack. This fear causes the person to withdraw into safer surroundings, and many agoraphobics will only frequent a few secure locations, such as their home, a specific route to work, or sometimes the homes of friends or relatives. They typically avoid bridges, tunnels, elevators, highways without shoulders, limited access roads with infrequent exits, or being in crowded places. In the extreme, they will not leave their home.

Agoraphobia almost always occurs with panic disorder, but can sometimes occur on its own. It is more appropriate to look at agoraphobia as the best explanation for a problem, rather than specific phobias, when there are many phobias, and when the theme common to all of the fears is a difficult escape. The most difficult part of treatment for agoraphobia is maintaining regular treatment appointments. People suffering with agoraphobia often have difficulty getting to the office of a psychologist, and frequently cancel appointments because of their fears. This must be addressed as part of treatment.

Specific Phobias

Phobias are also called Specific Phobias. These disorders are the phobias with which we are all familiar. A person has an anxiety response when exposed to a specific event or object, such as fear of snakes, or fear of flying. Phobias are divided into types, including animal type (fear of animals or insects), natural environment type (storms, heights, etc), blood-injection-injury type (seeing blood, getting a shot, etc.), and situational type (flying, tunnels, bridges, etc.).

The development of a specific phobia usually occurs either during childhood or in the mid-20s. Phobias are relatively common in the general population, but rarely diagnosed because people tend to manage their lives around the phobia, rather than seeking treatment. Sometimes a specific phobia will develop as a secondary problem following a trauma. For example, a person has a severe car accident, and becomes fearful of driving, or a person is attacked by a dog, and becomes fearful of animals. It is important to differentiate between reactions such as these, which may be part of a Post Traumatic Stress Disorder, versus a specific phobia, without a history of trauma.

Psychologists provide treatment for specific phobias using behavioral and cognitive therapy procedures. Desensitization is very effective, as well as the development of cognitive coping strategies. However, many people never seek treatment, unless the specific phobia interferes with life functioning in a significant way. For example, if a person has a fear of flying, they cannot accept a promotion that requires frequent travel without learning how to cope with their fear, or overcome it.

Obsessive Compulsive Disorder

Obsessive compulsive disorder (OCD) is an anxiety disorder in which the person experiences either obsessions or compulsions that interfere with normal life functioning. Obsessions are persistent ideas or thoughts or impulses that intrude on your thoughts, and cause significant distress in your life. Compulsions are repetitive behaviors that are performed in an effort to reduce anxiety. (Typically the anxiety is caused by obsessions). Approximately 2 percent of the population develop an obsessive compulsive disorder during their lifetime.

It is important to note that obsessions are not just excessive worrying about real problems, as that would be a generalized anxiety disorder. Also, the person with OCD typically tries to ignore these thoughts and ideas. An individual with a psychotic disorder may ruminate on a single idea, but would not try to avoid thinking about it, as obsessive ideas do not generate the same kind of personal distress when they occur as part of a psychotic process.

This disorder results in significant distress. Most people with OCD spend a lot of time during the day dealing with either obsessions, compulsions, or both. These obsessions and compulsions significantly interfere with their normal life functioning. OCD can develop in childhood, but most often it develops in adolescence or young adults.

Intrusive thoughts are very common in the general population. Most of the time, stress leads to intrusive thoughts, and individuals who are depressed are also more likely to develop intrusive thoughts. It appears that those people who develop an OCD response to these intrusive thoughts may have a severe biologically based emotional response to stress. It should be noted that OCD is very resistant to treatment, and an individual with OCD will need treatment over an extended period of time.


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