DR. NEAL HOUSTON

Adult Integrative/Behavioral Health Specialist

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Thursday, July 18, 2013

UNDERSTANDING THE ANXIETY


Anxiety disorders affect about 40 million American adults age 18 years and older (about 
18%) in a given year, causing them to be filled with fearfulness and uncertainty.



Anxiety is a normal reaction to stress and can actually be beneficial in some situations. For some people, however, anxiety can become excessive. While the person suffering may realize their anxiety is too much, they may also have difficulty controlling it and it may negatively affect their day-to-day living. There are a wide variety of anxiety disorders, including post-traumatic stress disorder, obsessive-compulsive disorder, and panic disorder to name a few. Collectively, they are among the most common mental disorders experienced by Americans.

Anxiety disorders do share several important similarities with mood disorders. From a descriptive point of view, both categories are defined in terms of negative emotional responses. A person with guilt, worry, and anger are examples of feelings that frequently accompany both anxiety and depression. Many patients who are anxious are also depressed, and similarly many patients who are depressed are also anxious.

The close relationship between symptoms of anxiety and those for depression suggest that these disorders may share common etiological features. In fact, clinicians and researchers have focused on similar considerations when investigating these disorders. Stressful life events play an important role in the onset of both depression and anxiety. Cognitive factors are also important in both types of problems. From a biological point of view, certain neurotransmitters such as serotonin are involved in the etiology of various types of anxiety disorders as well as mood disorders.

People with anxiety disorders share a preoccupation with, or persistent avoidance of, thoughts or situations that may provoke fear or anxiety. In some cases, the direct experience of fear or anxiety is characteristic of the disorder.

Anxiety disorders frequently have a negative impact on various aspects of a person's life. One hallmark of anxiety disorders is the paradoxical nature of the person's behavior. If people understand that they are harming themselves with their irrational actions, why do they persist in them? This question hinges on the fact that insight is rarely impaired in anxiety disorders. Some patients with anxiety disorders recognize this dilemma. They are going through excruciating discomfort, but they understand that there emotional responses are completely incongruent with reality.

Like depression, the term anxiety can refer to either a mood or a syndrome. For this purpose I will use the term to refer to a mood.

An Anxious Mood is often defined in contrast to the specific emotion of fear, which is more easily understood. Fear is experienced in the face of real, immediate danger. It usually builds quickly in intensity and helps to organize the person’s behavioral responses to threats from the environment (escaping or fighting back).  Anxieties involve a more general or diffuse emotional reaction. Beyond simple fear - that is out of proportion to threats from the environment. Rather than being directed toward a person's present circumstances, anxiety is typically associated with the anticipation of future problems.

Anxiety can be adaptive as well as productive at low levels, because it serves as a signal that we must prepare for an upcoming event. In contrast, high levels of anxiety become incapacitating as concentration and performance are disrupted.

A pervasive anxious mood is typically associated with pessimistic thoughts and feelings. The person’s attention may also turn inward, focusing on negative emotions and self-evaluation rather than on the organization or rehearsal of adaptive responses that might be useful in coping with negative events. Taken together, these factors can be used to define maladaptive anxiety, or what psychologists and researchers have called "anxious apprehension" which consists of:

  • high levels of diffuse negative emotion
  • a sense of uncontrolled ability
  • a shift in attention to a primary cell focus or a state of self-preoccupation

Perhaps because we all experience brief periods of anxiety, patients who suffer from anxiety disorders often find it difficult to describe the terrifying intensity of their experiences.
Worrying is one specific cognitive activity that is associated with anxiety. For many years psychologist and researchers have studied this phenomenon carefully because they considered it to be critical in the subclassification of anxiety disorders.

Worry can be looked at as a relatively uncontrollable sequence of negative, emotional thoughts and images that are concerned with possible future threats or danger. When excessive worriers are asked to describe their thoughts, they emphasize the predominance of verbal, linguistic material rather than images. In other words, worriers appear to be preoccupied with “self-talk” rather than unpleasant visual images.

Because everyone worries at least a little bit, you might wonder whether it is possible to distinguish between pathological and normal worry. The answer to this concern is “yes”. Excessive worriers are more likely than others to feel that the content of their thoughts are more negative in tone, that they feel that they have less control over the content and direction of their thoughts, and that in comparison to other adults; they believe that their worries are less realistic.


  • This evidence suggests that the crucial features of pathological worrying may be lack of control and negative affect rather than simply the anticipation of future events.


Signs & Symptoms

  • Unlike the relatively mild, brief anxiety caused by a stressful event (such as speaking in public or a first date), anxiety disorders last at least 6 months and can get worse if they are not treated. Each anxiety disorder has different symptoms, but all the symptoms cluster around excessive, irrational fear and dread.
  •  Anxiety disorders commonly occur along with other mental or physical illnesses, including alcohol or substance abuse, which may mask anxiety symptoms or make them worse. In some cases, these other illnesses need to be treated before a person will respond to treatment for the anxiety disorder. 
  • Effective therapies for anxiety disorders are available, and research is uncovering new treatments that can help most people with anxiety disorders lead productive, fulfilling lives. If you think you have an anxiety disorder, you should seek information and treatment right away.

A doctor must conduct a careful diagnostic evaluation to determine whether a person’s symptoms are caused by an anxiety disorder or a physical problem. If an anxiety disorder is diagnosed, the type of disorder or the combination of disorders that are present must be identified, as well as any coexisting conditions, such as depression or substance abuse. Sometimes alcoholism, depression, or other coexisting conditions have such a strong effect on the individual that treating the anxiety disorder must wait until the coexisting conditions are brought under control.

In general, anxiety disorders are treated with medication, specific types of psychotherapy, or both. Treatment choices depend on the problem and the person’s preference.

Cognitive-Behavioral Therapy (CBT) is very useful in treating anxiety disorders. The cognitive part helps people change their thinking patterns that support their fears, and the behavioral part helps people change the way they react to anxiety-provoking situations.

Cognitive-Behavioral Therapy or behavioral therapy often lasts about 12 weeks. It may be conducted individually or with a group of people who have similar problems. Group therapy is particularly effective for social phobia. There is some evidence that the benefits of Cognitive-behavioral therapy last longer than those of medication for people with panic disorder, and the same may be true for OCD, PTSD, and social phobia. If a disorder recurs at a later date, the same therapy can be used to treat it successfully a second time.


If you think you have an anxiety disorder, the first person you should see is your family doctor. A physician can determine whether the symptoms that alarm you are due to an anxiety disorder, another medical condition, or both.