Anxiety Disorder Test: Do I Have An Anxiety Disorder?
Written by Natasha Tracy
By Margarita Tartakovsky, M.S.
How to Support an Anxious PartnerHaving a partner who struggles with anxiety or has an anxiety disorder can be difficult.
“Partners may find themselves in roles they do not want, such as the compromiser, the protector, or the comforter,” says Kate Thieda, MS, LPCA, NCC, a therapist and author of the excellent book Loving Someone with Anxiety.
They might have to bear the brunt of extra responsibilities and avoid certain places or activities that trigger their partner’s anxiety, she said. This can be very stressful for partners and their relationship.
“Partners of loved ones with anxiety may find themselves angry, frustrated, sad, or disappointed that their dreams for what the relationship was going to be have been limited by anxiety.”
Thieda’s book helps partners better understand anxiety and implement strategies that truly support their spouses, without feeding into or enabling their fears.
Below, she shared five ways to do just that, along with what to do when your partner refuses treatment.
1. Educate yourself about anxiety.
It’s important to learn as much as you can about anxiety, such as the different types of anxiety disorders and their treatment. This will help you better understand what your partner is going through.
Keep in mind that your partner might not fit any of these categories. As Thieda writes in Loving Someone with Anxiety, “The truth is, it doesn’t matter whether your partner’s anxiety is ‘diagnosable.’ If it’s impairing your relationship or diminishing your partner’s quality of life or your own quality of life, it will be worthwhile to make changes.”
2. Avoid accommodating your partner’s anxiety.
“Partners often end up making accommodations for their partner’s anxiety, whether it is intentional [such as] playing the part of the superhero, or because it just makes life easier, as in, doing all the errands because their partner is anxious about driving,” said Thieda, who also created the popular blog “Partners in Wellness” on Psych Central.
However, making accommodations actually exacerbates your partner’s anxiety. For one, she said, it gives your partner zero incentive to overcome their anxiety. And, secondly, it sends the message that there really is something to fear, which only fuels their anxiety.
3. Set boundaries.
Your partner might continue asking for accommodations, such as having you drive everywhere or regularly stay home with them, Thieda said. “You have the right to have a life, too, and this may mean telling your partner on occasion, and in a loving way, that you are going to do what you want and need to do.”
In her book Thieda devotes an entire chapter to effectively communicating this to your partner. Essentially, she suggests being empathetic, using “I” statements and giving specific requests.
For instance, she gives the following examples: Instead of saying, “You worry too much about what other people think of you,” you might say, “I’m concerned that your fears about what others think of you are holding you back at work.”
Instead of saying, “Don’t call me at work so much,” you might say, “It would be helpful if you would try some of the techniques you’ve learned for calming yourself down before calling me at the office.”
Also, “always consider whether a compromise is possible, but also recognize that you have the right to do things independently,” she said.
4. Relax together.
There are many techniques you can try together to alleviate anxiety. According to Thieda, “The body scan is a great couples mindfulness technique because one person can guide the other through the process.”
This promotes mindfulness for both partners. The partner giving instructions needs to pay attention to timing and the specific directions, she said. And the partner receiving the instructions needs to pay attention to each body part and releasing its tension, she said. (Here’s a sample body scan.)
5. Focus on your own care.
According to Thieda in her book, “When you live with an anxious partner, there can be a lot of tension in your relationship and in your home. Having self-care routines and plans in place can help you neutralize the static.”
Consider what you’re already “doing to promote physical, spiritual, mental, emotional, professional, and relationship health,” Thieda said. Assessing where you are helps you better understand where you need to go. For instance, you might want to set goals about improving your health or seek support from others, she said. You might want to work with a therapist or attend support groups.
What to Do When Your Partner Refuses Treatment
Anxiety is highly treatable. But your partner might not want to seek professional help. Thieda suggested considering the reasons behind their refusal.
For instance, they might’ve tried treatment before but it didn’t work. One reason treatment “fails” is because it’s not the right treatment for the person’s anxiety. According to Thieda, “It is best to work with a professional who uses cognitive-behavioral therapy techniques and is specifically trained in working with people who struggle with anxiety.”
They might’ve tried medication or psychotherapy alone, but they’d do better with a combination of treatments, she said. It’s also possible that your partner tried to take on too much, and ended up feeling even more anxious. “Maybe they need to approach their treatment in a different way, breaking down the challenges into smaller, more manageable pieces.”
Ultimately, the decision to seek treatment rests with your partner, Thieda said. “No amount of begging, pleading, or threatening is going to be effective, and will likely make things worse.”
The best thing you can do is to be supportive, encouraging and loving when they do decide to seek help, she said.
Having a spouse who’s struggling with anxiety can naturally become stressful for partners. But while this can be challenging, by educating yourself, setting healthy boundaries and practicing self-care, you can truly help your spouse and your relationship.
Child Mind Institute
Kids who seem oppositional are often severely anxious
A 10-year-old boy named James has an outburst in school. Upset by something a classmate says to him, he pushes the other boy, and a shoving-match ensues. When the teacher steps in to break it up, James goes ballistic, throwing papers and books around the classroom and bolting out of the room and down the hall. He is finally contained in the vice principal’s office, where staff members try to calm him down. Instead, he kicks the vice principal in a frenzied effort to escape. The staff calls 911, and James ends up in the Emergency Room.
To the uninitiated, James looks like a boy with serious anger issues. It’s not the first time he’s flown out of control. The school insists that his parents pick him up and take him home for lunch every day because he’s been banned from the cafeteria.
But what’s really going on? “It turns out, after an evaluation, that he is off the charts for social anxiety,” reports Dr. Jerry Bubrick, director of the Anxiety & Mood Disorders Center at the Child Mind Institute. “He can’t tolerate any—even constructive—criticism. He just will shut down altogether. James is terrified of being embarrassed, so when a boy says something that makes him uncomfortable, he has no skills to deal with it, and he freaks out. Flight or fight.”
James’s story illustrates something that parents and teachers may not realize—that disruptive behavior is often generated by unrecognized anxiety. A child who appears to be oppositional or aggressive may be reacting to anxiety—anxiety he may, depending on his age, not be able to articulate effectively, or not even fully recognize that he’s feeling.
“Especially in younger kids with anxiety you might see freezing and clinging kind of behavior,” says Dr. Rachel Busman, a clinical psychologist at the Child Mind Institute, “but you can also see tantrums and complete meltdowns.”
A great masquerader
Anxiety manifests in a surprising variety of ways in part because it is based on a physiological response to a threat in the environment, a response that maximizes the body’s ability to either face danger or escape danger. So while some children exhibit anxiety by shrinking from situations or objects that trigger fears, some react with overwhelming need to break out of an uncomfortable situation. That behavior, which can be unmanageable, is often misread as anger or opposition.
“Anxiety is one of those diagnoses that is a great masquerader,” explains Dr. Laura Prager, director of the Child Psychiatry Emergency Service at Massachusetts General Hospital. “It can look like a lot of things. Particularly with kids who may not have words to express their feelings, or because no one is listening to them, they might manifest their anxiety with behavioral dysregulation.”
The more commonly recognized symptoms of anxiety in a child are things like trouble sleeping in his own room or separating from his parents, avoidance of certain activities, a behaviorally inhibited temperament. “Anyone would recognize those symptoms,” notes Dr. Prager, who is also an assistant professor at the Harvard Medical School, and co-author of Suicide by Security Blanket, and Other Stories from the Child Psychiatry Emergency Service. But in other cases the anxiety can be hidden.
“When the chief complaint is temper tantrums, or disruption in school, or throwing themselves on the floor while shopping at the mall, it’s hard to know what that means,” she explains, “but it’s not uncommon, when kids like that come in to the ER, for the diagnosis to end up being a pretty profound anxiety disorder.”
To demonstrate the surprising range of ways young children express anxiety, Dr. Prager mentions a case she had just seen of a young child who presented with hallucinations, but whose diagnosis she predicted will end up being somewhere on the anxiety spectrum. “Little kids who say they’re hearing things or seeing things, for example, may or may not be doing that. These may not be the frank hallucinations we see in older patients who are schizophrenic, for example. They might be a manifestation of anxiety and this is the way the child expresses it.”
Problems at school
It’s not uncommon for children with serious undiagnosed anxiety to be disruptive at school, where demands and expectations put pressure on them that they can’t handle. And it can be very confusing to teachers and other staff members to “read” that behavior, which can seem to come out of nowhere.
Dr. Nancy Rappaport, a Harvard Medical School professor who specializes in mental health care in school settings, sees anxiety as one of the causes of disruptive behavior that makes classroom teaching so challenging. “The trouble is that when kids who are anxious become disruptive they push away the very adults who they need to help them feel secure,” notes Dr. Rappaport. “And instead of learning to manage their anxiety, they end up spending half the day in the principal’s office.”
Dr. Rappaport sees a lot of acting out in school as the result of trauma at home. “Kids who are struggling, not feeling safe at home,” she notes, “can act like terrorists at school, with fairly intimidating kinds of behavior.” Most at risk, she says, are kids with ADHD who’ve also experienced trauma. “They’re hyper-vigilant, they have no executive functioning, they misread cues and go into combat.”
When a teacher is able to build a relationship with a child, to find out what’s really going on with him, what’s provoking the behavior, she can often give him tools to handle anxiety and prevent meltdowns. In her book, The Behavior Code: A Practical Guide to Understanding and Teaching the Most Challenging Students, Dr. Rappaport offers strategies kids can be taught to use to calm themselves down, from breathing exercises to techniques for distracting themselves.
“When a teacher understands the anxiety underlying the opposition, rather than making the assumption that the child is actively trying to make her miserable, it changes her approach,” says Dr. Rappaport, “The teacher is able to join forces with the child himself and the school counselor, to come up with strategies for preventing these situations.” If it sounds labor-intensive for the teacher, it is, she notes, but so is dealing with the aftermath of the same child having a meltdown.
Anxiety also drives a lot of symptoms in a school setting that are easily misconstrued as ADHD or oppositionality.
“I’ll see a child who’s having difficulty in school: not paying attention, getting up out of his seat all the time, asking a lot of questions, going to the bathroom a lot, getting in other kids’ spaces,” explains Dr. Busman. “His behavior is disrupting other kids, and is frustrating to the teacher, who’s wondering why she has to answer so many questions, and why he’s so wrapped up in what other kids are doing, whether they’re following the rules.”
People tend to assume what’s happening with this child is ADHD inattentive type, but it’s commonly anxiety. Kids with OCD, mislabeled as inattentive, are actually not asking all those questions because they’re not listening, but rather because they need a lot of reassurance.
How to identify anxiety
“It probably occurs more than we think, either anxiety that looks disruptive or anxiety coexisting with disruptive behaviors,” Dr. Busman adds. “It all goes back to the fact that kids are complicated and symptoms can overlap diagnostic categories, which is why we need to have really comprehensive and good diagnostic assessment.”
First of all, good assessment needs to gather data from multiple sources, not just parents. “We want to talk to teachers and other people involved with the kid’s life,” she adds, “because sometimes kids that we see are exactly the same at home and at school, sometimes they are like two different children.”
And it needs to use rating scales on a full spectrum of behaviors, not just the area that looks the most obvious, to avoid missing things.
Dr. Busman also notes that a child with severe anxiety who’s struggling in school might also have attentional or learning issues, but she might need to be treated for the anxiety before she can really be evaluated for those. She uses the example of a teenager with OCD who she’s “doing terribly” in school. “She’s ritualizing three to four hours a day, and having constant intrusive thoughts—so we need to treat that, to get the anxiety under control before we ask, how is she learning?”
Written by Natasha Tracy
The specific causes of anxiety disorders are unknown, in spite of one-in-eight Americans being affected by them. As with most mental illnesses, anxiety disorders are thought to be caused by a combination of factors. It’s likely genetic, psychological and environmental factors come together to cause anxiety disorders. Medical conditions are also known to cause an anxiety disorder.
Medical Causes of an Anxiety Disorder
While anxiety can be experienced by anyone, for many people an anxiety disorder is linked to an underlying medical issue. In some cases, a medical issue may cause an anxiety disorder. In other cases, anxiety and the medical condition may be related, but the medical condition may not have caused the anxiety disorder.
Possible medical causes include:1
•Thyroid problems (such as hypothyroidism or hyperthyroidism)
•Drug abuse and withdrawal (alcohol and benzodiazepines may particularly cause anxiety)
•Rare tumors that produce certain “fight-or-flight” hormones
•Muscle cramps or spasms
•And many others
While most anxiety disorders develop in childhood and young adulthood, a medical cause is more likely if the anxiety disorder develops later in life. While common, anxiety disorders related to substance abuse or withdrawal are often undiagnosed. Various medications may also cause anxiety disorder symptoms.
Genetic Causes of Anxiety Disorders
While an exact gene hasn’t been pinpointed, it’s thought that genetics play a role in causing anxiety disorders, or at least for increasing the risk of getting an anxiety disorder. Anxiety disorders and genetics have been shown to be linked through chromosomal irregularities, among other things. These findings are confirmed by studies using twins.
The link between anxiety disorders and genetics is better understood for specific disorders. For example, in panic disorder, a gene mutation that leads to dysfunction in the chemical systems of the brain has been identified. Additional likely genetic links include:
•An abnormal increased function in some brain receptors; an abnormal decreased function in others
•An imbalance of chemicals, like cortisol, linked to feelings of stress
•Impaired carbon dioxide receptors, leading to a state of chronic hyperventilation
Obsessive-compulsive disorder has shown a strong genetic link with a genetic influence of 45% – 65% in children and 27% – 47% in adults.
Everyone feels anxious from time to time. Stressful situations such as meeting tight deadlines or important social obligations often make us nervous or fearful. Experiencing mild anxiety may help a person become more alert and focused on facing challenging or threatening circumstances.
But individuals who experience extreme fear and worry that does not subside may be suffering from an anxiety disorder. The frequency and intensity of anxiety can be overwhelming and interfere with daily functioning. Fortunately, the majority of people with an anxiety disorder improve considerably by getting effective psychological treatment.
What are the major kinds of anxiety disorders?
There are several major types of anxiety disorders, each with its own characteristics.
People with generalized anxiety disorder have recurring fears or worries, such as about health or finances, and they often have a persistent sense that something bad is just about to happen. The reason for the intense feelings of anxiety may be difficult to identify. But the fears and worries are very real and often keep individuals from concentrating on daily tasks.
Panic disorder involves sudden, intense and unprovoked feelings of terror and dread. People who suffer from this disorder generally develop strong fears about when and where their next panic attack will occur, and they often restrict their activities as a result.
A related disorder involves phobias, or intense fears, about certain objects or situations. Specific phobias may involve things such as encountering certain animals or flying in airplanes, while social phobias involve fear of social settings or public places.
Obsessive-compulsive disorder is characterized by persistent, uncontrollable and unwanted feelings or thoughts (obsessions) and routines or rituals (compulsions) in which individuals engage to try to prevent or rid themselves of these thoughts. Examples of common compulsions include washing hands or cleaning house excessively for fear of germs, or checking work repeatedly for errors.
Someone who suffers severe physical or emotional trauma such as from a natural disaster or serious accident or crime may experience post-traumatic stress disorder. Thoughts, feelings and behavior patterns become seriously affected by reminders of the event, sometimes months or even years after the traumatic experience.
Symptoms such as extreme fear, shortness of breath, racing heartbeat, insomnia, nausea, trembling and dizziness are common in these anxiety disorders. Although they may begin at any time, anxiety disorders often surface in adolescence or early adulthood. There is some evidence that anxiety disorders run in families; genes as well as early learning experiences within families seem to make some people more likely than others to experience these disorders.
Why is it important to seek treatment for these disorders?
If left untreated, anxiety disorders can have severe consequences. For example, some people who suffer from recurring panic attacks avoid any situation that they fear may trigger an attack. Such avoidance behavior may create problems by conflicting with job requirements, family obligations or other basic activities of daily living.
People who suffer from an untreated anxiety disorder often also suffer from other psychological disorders, such as depression, and they have a greater tendency to abuse alcohol and other drugs. Their relationships with family members, friends and coworkers may become very strained. And their job performance may decline.
Are there effective treatments available for anxiety disorders?
Absolutely. Most cases of anxiety disorder can be treated successfully by appropriately trained mental health professionals such as licensed psychologists. Research has demonstrated that a form of psychotherapy known as “cognitive-behavioral therapy” (CBT) can be highly effective in treating anxiety disorders. Psychologists use CBT to help people identify and learn to manage the factors that contribute to their anxiety.
Behavioral therapy involves using techniques to reduce or stop the undesired behaviors associated with these disorders. For example, one approach involves training patients in relaxation and deep breathing techniques to counteract the agitation and rapid, shallow breathing that accompany certain anxiety disorders.
Through cognitive therapy, patients learn to understand how their thoughts contribute to the symptoms of anxiety disorders, and how to change those thought patterns to reduce the likelihood of occurrence and the intensity of reaction. The patient’s increased cognitive awareness is often combined with behavioral techniques to help the individual gradually confront and tolerate fearful situations in a controlled, safe environment.
Along with psychotherapy, appropriate medications may have a role in treatment. In cases where medications are used, the patient’s care may be managed collaboratively by more than one provider of treatment. It is important for patients to realize that there are side effects to any drugs, which must be monitored closely by the provider who prescribed the medication.
How can licensed psychologists help someone suffering from an anxiety disorder?
Licensed psychologists are highly trained and qualified to diagnose and treat people with anxiety disorders using techniques based on best available research. Psychologists’ extensive training includes understanding and using a variety of psychotherapies, including CBT.
Psychologists sometimes use other approaches to effective treatment in addition to individual psychotherapy. Group psychotherapy, typically involving unrelated individuals who all have anxiety disorders, can be an effective approach to delivering treatment and providing support. Further, family psychotherapy can help family members better understand their loved one’s anxiety and learn new ways of interacting that do not reinforce the anxiety and associated dysfunctional behaviors.
Individuals suffering from anxiety disorders may also want to consider mental health clinics or other specialized treatment programs dealing with specific anxiety disorders such as panic or phobias that may be available in their local area.
How long does psychological treatment take?
The large majority of people who suffer from an anxiety disorder are able to reduce or eliminate their anxiety symptoms and return to normal functioning after several months of appropriate psychotherapy. Indeed, many people notice improvement in symptoms and functioning within a few treatment sessions. The patient should be comfortable from the outset with the psychotherapist. Together the patient and psychotherapist should develop an appropriate treatment plan. The patient’s cooperation is crucial, and there must be a strong sense that the patient and therapist are collaborating well as a team to treat the anxiety disorder.
No one plan works well for all patients. Treatment needs to be tailored to the needs of the patient and to the type of disorder, or disorders, from which the individual suffers. The psychotherapist and patient should work together to assess whether a treatment plan seems to be on track. Patients respond differently to treatment, and adjustments to the plan sometimes are necessary. Anxiety disorders can severely impair a person’s functioning in work, family and social environments. But the prospects for long-term recovery are good for most individuals who seek appropriate professional treatment. People who suffer from anxiety disorders can work with a qualified and experienced mental health professional such as a licensed psychologist to help them regain control of their feelings and thoughts — and their lives.
Printable version of this article (PDF, 455KB)
By Marie Suszynski
Thanks to the fight-or-flight response, we’re engineered to feel anxiety when we’re about to face something that has scared us in the past. It could be speaking in front of a group of people, flying on an airplane, or going out on a first date, says Simon A. Rego, PsyD, supervising psychologist at Montefiore Medical Center and assistant clinical professor of psychiatry and behavioral sciences at Albert Einstein College of Medicine, both in the Bronx, N.Y. This fear is known as anticipatory anxiety.
Sweaty palms, racing heart, and upset stomach are the body’s natural ways of preparing for the event. We’re programmed to anticipate the worst, Rego says, because it’s our body’s way of ensuring we’ll get out of the situation if it is dangerous.
Problem is, most of the time when we experience anticipatory anxiety, we’re not about to put ourselves in any real danger. By gaining a better understanding of such anxiety problems, you can ultimately limit their negative effects on your life.
Anxiety Side Effects: Panic Attacks and Anticipatory Anxiety
Everyone has anticipatory anxiety at some point, Rego says. You don’t have to have a psychiatric anxiety disorder or anxiety problems to experience it.
However, anticipatory anxiety is a component of panic disorder. By definition, someone with panic disorder has panic attacks that include classic anxiety side effects and symptoms, such as:
Shortness of breath
Numbness or tingling
Hot flashes or cold chills
The physical symptoms of panic attacks are so intense in some people that they think they’re dying or having a heart attack.
For people with panic disorder, their first panic attack is completely unexpected. But after the first attack, someone with panic disorder will experience anticipatory anxiety because she fears that a panic attack will happen again.
The same is true for other anxiety disorders. People who have phobias have anticipatory anxiety about what they fear and are excessively careful to avoid it, even if it means driving across the country to avoid getting on a plane.
Anxiety Side Effects: Anticipatory Anxiety Symptoms
Rego describes anticipatory anxiety symptoms as “feeling your engine rev” as you face doing something that scares you. Anxiety side effects include a racing heart, sweaty palms, and trembling.
Anticipatory anxiety can be chronic if you find yourself worried about something for months at a time, such as losing your job in a poor economy. Besides feeling anxious and fearful, you may also experience anger, confusion, hopelessness, loss of control, numbness, sadness, moodiness, irritability, guilt, and preoccupation with the threat, to the point where you can’t concentrate or make decisions.
If anticipatory anxiety is chronic, you may also find that you’re withdrawing from people and things you enjoy doing. You may have memory problems and physical symptoms such as:
Changes in sleep patterns
Changes in appetite
Anxiety Side Effects: Managing Anticipatory Anxiety
It’s only natural to want to avoid the things that make you anxious. But the only way to get over anticipatory anxiety is to go toward what’s making you fearful rather than backing away, Rego says.
For example, if you’re anxious about public speaking, a therapist will have you give speech after speech, “until you’re doing it so much that you get used to it,” Rego says. That way, you challenge your fears and learn that giving a speech does not mean inevitable doom, and you become less anxious.
If you’re feeling chronic anticipatory anxiety, ask yourself how realistic your fears are and remind yourself that you can cope with what’s to come.
Remember that the body is great at adapting, Rego says. As long as you continue to do the things you fear, your anticipatory anxiety should subside. Short-term use of medications that calm anxiety may also be useful — talk to your doctor to find out what is best for you.
By MIKE GROPPER
The condition affects around 3.5 percent of the population during their lifetimes. What treatments exist to prevent attacks?
Coping with panic.
Josh is a 35-year-old man who came to me for help dealing with his long history of panic attacks. They started after his army service and have continued off and on ever since.
Josh explained that as a result of his panic attacks, he only goes to work and avoids most social gatherings. Describing a typical anxiety attack, he explained that his breathing becomes very heavy and he feels like he is choking, gasping for air. His heart often pounds and he is certain that he having a heart attack. He added that when he has a panic attack, he feels like he is losing complete control and is going crazy, and finds himself hyperventilating and terrified that he is going to die or that something terrible will happen. He sought my help because he was tired of living a life of fear and avoiding friends and social places. Josh’s wife also strongly encouraged him to seek help and was hoping that professional treatment would help alleviate his suffering.
Josh is not alone. Panic disorder affects around 3.5 percent of the population during their lifetimes, affecting twice as many women as men. At least 23% of the general population has reported an isolated panic attack some time in their lives. The average age of onset for panic disorder is from adolescence to 40. Panic disorder often cooccurs with depression and other anxiety disorders, for instance on exposure to the feared object in specific phobia, the fearprovoking memory in post-traumatic stress disorder, the obsessive thought in obsessivecompulsive disorder, or a social phobia.
People like Josh frequently show up at hospital emergency rooms with a whole array of frightening physical symptoms, which become the focus of their anxiety and in fact trigger more anxiety. This is not surprising if one considers the intensity and degree of physical manifestations present in a typical panic attack. Many sufferers from panic disorder lose all semblance of rationality when they are going through an attack. Furthermore, they live in constant fear that the next attack is right around the corner.
Josh’s avoidance of social situations and people outside of his work is one of the most common fallouts of panic disorder. In describing his symptoms, Josh noted that he had always taken buses to work, but after having a powerful anxiety attack while waiting for a bus, he subsequently began to avoid bus travel. Instead, he began to take taxis to work, which led to a major dispute with his wife because of the expense involved.
THE BEST and most scientifically proven treatment for panic disorder is a combination of psychiatric medication, usually in the category of selective serotonin reuptake inhibitors (SSRIs), like Prozac, together with cognitive-behavioral treatment (CBT). As a rule, there are some important considerations to rule out when someone seeks out psychological help for panic disorder.
A complete physical exam is always recommended to make sure there are no underlying medical conditions that could be causing panic symptoms. The therapist must make sure that there is no current drug use that may be triggering the panic attacks.
Use of stimulants such as caffeine, decongestants, cannabis and cocaine can cause panic attacks. It is also important to know whether the panic attacks are part of a longterm pattern or just some isolated cases. For example, an evaluation may reveal that a trigger, such as being near or involved in a traumatic experience like a terror attack, has brought on the panic attacks.
CBT helps patients to understand how automatic thoughts and false beliefs/distortions lead to exaggerated emotional responses, such as anxiety, and how they can lead to secondary behavioral consequences.
Josh found psycho-education about panic attacks to be very helpful. Cognitive restructuring (CR), a central component of CBT, helped Josh to change some of the negative thinking that reinforces and maintains a panic episode. CR involves substituting positive thoughts (e.g. “I am only feeling a little uneasiness” or “my feelings will soon be gone”) for the maladaptive thoughts that accompany panic (e.g. clients feeling that they are having a heart attack or going to die).
Two points that significantly helped him were to understand that the panic attack rarely lasts more than 10 minutes and that many of the symptoms that his body was producing would not really hurt him. It helped to realize that his symptoms were the result of a rush of adrenaline released by the brain during the panic episode. Experts understand that the individual’s subjective reactions to the panic episode and the frightening events that follow are a central culprit in escalating the attack.
While panic disorder is a terrible and frightening psychiatric condition, help most definitely exists.
The writer is a psychotherapist for children, adults and couples and practices in Jerusalem, Tel Aviv and Ra’anana.
By Rick Nauert PhD
Turns out, the inability to block out fear during adolescence may be an innate trait.
In a new study, Weill Cornell Medical College researchers determined that once a teenager’s brain is triggered by a threat, the ability to suppress an emotional response to the threat is diminished.
This finding may explain the peak in anxiety and stress-related disorders during this developmental period.
The study, published in the online edition of the Proceedings of the National Academy of Sciences, is the first to decode fear acquisition and fear “extinction learning,” down to the synaptic level.
Researchers studied the brains of mice, which mirror human neuronal networks in addition to performing human experiments.
A key finding is that while acquired fear can be difficult to extinguish in some adolescents, adults and children do not have the same trouble learning when a threat is no longer present.
“This is the first study to show, in an experiment, that adolescent humans have diminished fear extinction learning,” said the study’s lead author, Dr. Siobhan S. Pattwell.
“Our findings are important because they might explain why epidemiologists have found that anxiety disorders seem to spike during adolescence or just before adolescence. It is estimated that over 75 percent of adults with fear-related disorders can trace the roots of their anxiety to earlier ages.”
The study findings suggest there is altered plasticity in the prefrontal cortex of the brain during adolescence, with its inability to overcome fear, said the study’s senior co-investigator, Dr. Francis Lee.
“This study is the first to show activity, at the synaptic level, for both fear acquisition and fear extinction — and we find that while these areas function well in both younger and older mice, neurons involved in fear extinction are not as active in adolescent mice,” said Lee.
“The new knowledge that a teenagers brain’s synaptic connections may not respond optimally will help clinicians understand that the brain region used in fear extinction may not be as efficient during this sensitive developmental period in adolescents.”
Fear learning is a highly adaptive, evolutionarily conserved process that allows one to respond appropriately to cues associated with danger.
In the case of psychiatric disorders, however, fear may persist long after a threat has passed, and this unremitting and often debilitating form of fear is a core component of many anxiety disorders, including post-traumatic stress disorder (PTSD).
Existing treatments include exposure therapy — designed to expose an individual slowly to the cues associated with a perceived threat. This technique is used for a variety of fears, from wartime PTSD to fear of flying, as well as serious adolescent anxiety about school, said Lee.
Anxiety disorders are increasingly being diagnosed in children and adolescents, but the success rate of fear extinction-based exposure therapies are currently not known in this population. This study aimed to discover if they could be effective — and why or why not.
The human experiment asked a group of volunteers — children, adolescents and adults –to wear headphones and skin sweat meters while looking at a computer screen with a sequence of blue or yellow square images.
One of the squares was paired with a really unpleasant sound. For example, 50 percent of the time the blue square would set off the noise.
If the participants acquired a fear of the noise, they showed increased sweat when viewing the image that was paired with it, said Pattwell.
The same group was brought back the next day, and again viewed a sequence of blue or yellow squares, but this time there was no associated noise. “But teenagers didn’t decrease their fear response, and maintained their fear throughout subsequent trials when no noise was played,” she said.
However, the researchers documented that, unlike the teens participating in this study aged 12-17, both children and adults quickly learned that neither square was linked to a noxious sound, and this understanding rapidly decreased their fear response.
According to researchers there is much more to explore about the fear response and its decoding in human adolescents, such as whether genes contribute to susceptibility to altered fear learning, and most importantly, what can be done to help the adolescent population overcome fear.
“We need to investigate personalized approaches to treatment of these fear and anxiety disorders in teens,” said Lee.
“It is essential that we find a way to help teenagers become more resilient to the fear they experience during adolescence to prevent it from leading to a lifetime of anxiety and depression.”
Source: New York- Presbyterian Hospital/Weill Cornell Medical Center/Weill Cornell Medical College
By Jessica Minahan, M.Ed, BCBA
The Anxiety Disorders Association of America reports one in eight children suffer from anxiety disorders. Without intervention, they’re at risk for poor performance, diminished learning and social/behavior problems in school. Because anxiety disorders show up differently in children, parents and teachers can’t always identify them until the child hits the breaking point.
When a student acts out—throws a book, yells, storms out of the room—or has difficulty learning to read or grasping new math concepts, teachers often don’t suspect anxiety as the underlying cause, which means the problems may persist or worsen. This fall, I consulted with Mr. Lee, an exasperated third grade teacher. “I want to give up,” he said, slumping in his chair. Mr. Lee is one of the most thoughtful, talented teachers I’ve worked with. It’s unusual to see him so defeated. He related an incident from that morning’s math class.
Mark was in a great mood. He loves math, especially math fact bingo, which was on the agenda for the day. As always, Mr. Lee asked Mark if he would like to pass out the pencils. Mark asks to do this almost daily because he says he “likes to get up and move.” Today Mr. Lee had barely finished the question when Mark jumped out of his seat, swiped the contents of his desk on the floor, screamed, “I hate this school!” and ran from the room. “It came out of the blue!” Mr. Lee said.
“Out of the blue” behavior
When I hear a teacher report a student’s challenging behavior “comes out of nowhere” or is “totally unpredictable,” I begin to suspect anxiety. Teachers are trained to recognize behavior patterns (“Carl always gets frustrated during math.”, or “Maria often cries when asked to read aloud.”), but some students with anxiety don’t show clear patterns. Anxiety levels fluctuate throughout the day, based on many variables, making the student’s behavior seem erratic. Think of an unopened soda can. You can’t know if it’s been shaken until you open it and it explodes. Similarly, it’s difficult to see how shaken a student is in any given moment until he acts out.
When Mark was asked to pass out pencils on Monday he did it with a smile on his face. On Tuesday, he said “Great!” when asked. But on Wednesday he totally blows up. The outburst has little to do with distributing pencils. It’s due to the high level of anxiety Mark was experiencing at the moment he was asked. On that day the request was the last straw.
Effects on Academics
This invisible disability can greatly affect academic performance as well. Anxiety impacts a student’s working memory, making it difficult to learn and retain information. The anxious student works and thinks less efficiently, which significantly affects the student’s learning capability. One study showed children who were the most anxious in the autumn of first grade were almost eight times more likely to be in the lowest quartile of reading achievement and almost 2½ times more likely to be in the lowest quartile in math achievement by spring of first grade.
What’s worse, academic performance can be hindered in an inconsistent way due to the student’s fluctuating level of anxiety. This leaves teachers befuddled and left to make their own conclusions.
Mr. Lee expressed his confusion. “Yesterday Mark wrote three exceptional paragraphs and today he didn’t finish a single sentence. Is he tired? Is he lazy today?”
This inconsistent presentation is unique to anxiety. Other disabilities, such as a reading disability, are much more predictable. A student with dyslexia doesn’t read a chapter flawlessly one day and then struggle over a sentence in the same book the next day. Teachers aren’t accustomed to thinking of disabilities as affecting kids only some of the time.
Recognizable Effects on Behavior
Without obvious signs, like sweating, shaking or blushing, anxiety is difficult to detect. The good news is that anxiety isn’t always totally invisible. A teacher can learn to recognize the more elusive behavior signs—increased inflexibility, over-reactivity, emotional intensity, and impulsivity. Many anxious students try to escape or avoid something through behavior, for instance going to the nurse to avoid a math quiz or acting up to be kicked out of chorus. Just as with a child who has oppositional behavior disorder, reactions may be tantrums, constant arguments or angry and disruptive acting-out. The form the behavior takes isn’t particularly distinctive – the only difference between oppositional and anxiety-related behavior is the underlying cause.
Educating teachers about anxiety and the behavioral signs they may see in the classroom makes this invisible disability easier to detect and understand. Mr. Lee learned to expect the unexpected while gaining an understanding of anxiety. The trained teacher is on the way to intervening effectively, turning the tide for the student’s academic and behavioral performance.
Jessica Minahan, M.Ed, BCBA, is a board-certified behavior analyst and special educator in the Newton, Massachusetts public school system. She is the co-author of The Behavior Code: A Practical Guide to Understanding and Teaching the Most Challenging Students, written with Nancy Rappaport, M.D. (jessicaminahan.com)
Alice Boyes, Ph.D.
Anxiety symptoms fall into five categories. Different types of anxiety symptoms are characteristically associated with different anxiety disorders, but there is overlap.
1. Physical anxiety symptoms
Most common anxiety symptoms are part of our evolved fight/flight/freeze response. For example, increased heart rate for running and fighting. Blood flow increases to your large muscles. It also moves away from your extremities so you’re less likely to bleed out if you lose a finger in a fight, and this can result in tingling or numbness in hands and feet. Goosebumps are related to making hair stand on end to make animals look larger and scarier, and thereby discourage predators (think: cats). Sweating is part of cooling and making animals more slippery. People with panic disorder, health anxiety, and social anxiety tend to over-monitor their physical sensations.
One type of social anxiety involves fear of blushing. Paradoxically, blushing is often associated with more positive evaluations rather than more negative. It’s thought blushing evolved because it helped with social cohesion e.g., when we communicate embarrassment or shame it most often provokes caring in others. High worriers often have problems with muscle aches and tension (shoulders, wrists, jaw etc.). People often have “catastrophic cognitions” about their physical symptoms of anxiety. They worry that physical symptoms of anxiety are signs of illness (“Have I got M.S?”) or “going crazy.”
2. Cognitive anxiety symptoms (thoughts)
People with social anxiety often worry that their anxiety will be obvious to others or that people will judge them as boring, stupid, or unattractive. People often worry about being incapacitated by anxiety or losing control due to anxiety. There is a form of Obsessive Compulsive Disorder in which the sufferer fears they will become a pedophile, despite no evidence for this. People with Generalized Anxiety Disorder often worry that their frequent worrying will harm them. Paradoxically, they often also believe that worry is necessary for being prepared / not making mistakes.
People with anxiety tend to overestimate the likelihood of negative things happening, but most importantly they underestimate their ability to cope if something negative did happen. For example, they underestimate their ability to cope if they did get “dumped” by a friend. Anxiety often causes people to lose confidence in themselves. People’s thinking tends to become more all-or-nothing when they’re anxious. You might find you can’t see the wood for the trees or that your thinking feels rigid and that thoughts seem to get stuck.
3. Behavioral symptoms of anxiety
Avoidance is the number 1 behavioral symptom of anxiety. People avoid situations and actions they fear will trigger anxiety or where they’ll be unable to escape. People might avoid situations in which they fear they will not be able to perform as perfectly as they would like. People may overcompensate for anxiety by working extra hard. Many types of anxiety involve both over-checking and under-checking. For example, someone with an eating disorder who is anxious about their weight might sometimes weigh themselves very frequently or sometimes avoid weighing themselves, or check their appearance in mirrors a lot or avoid this.
4. Affective anxiety symptoms (emotions)
Affect is the felt experience of an emotion. Anxiety obviously feels like anxiety, but other emotions are commonly felt by people who are anxious. For example, irritability and hopelessness.
5. Interpersonal Anxiety Symptoms
There are lots of interpersonal symptoms of anxiety. People with panic disorder, generalized anxiety, health anxiety, eating disorders, obsessive-compulsive disorder, or social anxiety may do a lot of reassurance seeking, especially with their romantic partners. People who are anxious might avoid sex because the physical sensations (e.g., increased heart rate and body temperature) feel too similar to symptoms of anxiety. People with anxiety sometimes fear being dependent or incompetent and this has relationship implications. People may snap at partners or other family due to anxiety-induced irritability.
Cognitive Behavioral Therapy (CBT) is generally considered the best treatment for anxiety. You can try some Cognitive Behavioral Therapy exercises yourself. on my therapy website AliceBoyes.com
About the author
You can find @DrAliceBoyes on Twitter or join my Facebook page where I ask happiness questions, do 30 day projects, and talk about how I use psychology in my own life. https://www.facebook.com/DrAliceBoyes.
One of the ways in which people base their emotional responses to others is by assessing the facial expressions of those around them. If a person is confronted with an angry facial expression, they may respond with fear and worry. In contrast, when confronted with a neutral facial expression, an individual may have little or no emotional response. This technique of eliciting emotional response through facial expressions is one that is widely used in the research of psychological issues such as depression and anxiety. It has been shown that people with mental health challenges are often unable to accurately assess the expressions of others. Further facial expression research could help to untangle the factors that lead to maladaptive responses.
To better understand how facial expressions impact responses in people with anxiety, Oliver Langner of the Behavioral Science Institute at Radboud University Nijmegen in the Netherlands recently conducted a study that evaluated how people responded to low spatial frequencies (LSFs) as compared to high spatial frequencies (HSFs). LSFs refer to the facial expressions a person makes, while HSFs refer to the intricate details of a person’s face, such as the shape of the face and fine lines and wrinkles. In the study, Langner enlisted 39 college students, half of whom had been diagnosed with social anxiety. He created hybrid faces designed to elicit different emotional reactions on both LSF and HSF levels. The participants were instructed to rate the facial expressions and also to assess them during a learning experiment.
Langner discovered that the participants with social anxiety had more negative reactions to the LSF data than the nonanxious individuals. In addition, the anxious participants exhibited increased levels of sensitivity to the expressions of the hybrid faces during the learning task. Although all of the participants were aware of the HSF nuances, neither group demonstrated any noticeable impairment as a result of HSF specifics. The LSFs, the expressions of anger or ambiguity, were what drove the responses in the participants. These findings suggest that facial expressions influence the early emotional reactivity of individuals with anxiety but that the effects of HSF are less evident. Langner added, “Consequently, future research is needed that combines stimulus variations in spatial frequencies with varying tasks that are more sensitive to early processing stages.”
Langner, O., Becker, E. S., Rinck, M. (2012). Higher sensitivity for low spatial frequency expressions in social anxiety: Evident in indirect but not direct tasks? Emotion. Advance online publication. doi: 10.1037/a0028761
By Janice Wood Associate News Editor
A University of Houston researcher has found that patients suffering from anxiety disorders showed the most improvement when treated with cognitive-behavioral therapy (CBT) — in conjunction with a “transdiagnostic” approach, which allows therapists to use one kind of treatment no matter what the anxiety.
The problem up to now, according to Peter Norton, Ph.D., an associate professor in clinical psychology and director of the Anxiety Disorder Clinic at the University of Houston, has been that each anxiety disorder — such as panic disorder, obsessive-compulsive disorder (OCD), post-traumatic stress disorder (PTSD), social anxiety disorder, and phobias — has had a targeted treatment.
The transdiagnostic approach recognizes that many overlapping dimensions exist among these anxiety disorders. It suggests that thinking about anxiety disorders as a whole from a behavioral dimension and/or psychological dimension perspective may yield important insights into these disorders.
Norton, who says the specific treatments aren’t all that different from each other, has shown that a combination of CBT with the transdiagnostic approach has proven more effective than CBT combined with other types of anxiety disorder treatments, such as relaxation training.
“The Diagnostic and Statistical Manual of Mental Disorders (DSM) has been an important breakthrough in understanding mental health, but people are dissatisfied with its fine level of differentiation,” he said. The DSM uses a categorical approach to classifying mental disorders, including anxiety concerns.
“Panic disorders are considered something different from social phobia, which is considered something different from PTSD. The hope was that by getting refined in the diagnosis we could target interventions for each of these diagnoses, but in reality that just hasn’t played out.”
Norton’s research began 10 years ago when he was a graduate student in Nebraska and found he couldn’t get enough people together on the same night to run a group session for social phobia.
“What I realized is that I could open a group to people with anxiety disorders in general and develop a treatment program regardless of the artificial distinctions between social phobia and panic disorder, or obsessive-compulsive disorder, and focus on the core underlying things that are going wrong,” said Norton.
He says cognitive-behavioral therapy, which has a specific time frame and goals, is the most effective treatment as it helps patients understand the thoughts and feelings that influence their behaviors. The twist for him was using CBT in conjunction with the transdiagnostic approach.
The patients receiving the transdiagnostic treatment showed considerable improvement, especially with treating comorbid diagnoses, a disease or condition that co-exists with a primary disease and can stand on its own as a specific disease, like depression. Anxiety disorders often occur with a secondary illness, such as depression or substance and alcohol abuse, he noted.
“What I have learned from my past research is that if you treat your principal diagnosis, such as social phobia, you are going to show improvement on some of your secondary diagnosis,” he said. “Your mood is going to get a little better, your fear of heights might dissipate. So there is some effect there, but when we approach things with a transdiagnostic approach, we see a much bigger impact on comorbid diagnoses.”
“In my research study, over two-thirds of [co-existing] diagnoses went away, versus what we typically find when I’m treating a specific diagnosis such as a panic disorder, where only about 40 percent of people will show that sort of remission in their secondary diagnosis,” he continued.
“The transdiagnostic treatment approach [appears to be] more effiient in treating the whole person rather than just treating the diagnosis… then treating the next diagnoses.”
Norton notes the larger contributions of the studies are to guide further development and interventions for how clinical psychologists, therapists and social workers treat people with anxiety disorders. The data collected will be useful for people out on the front lines to effectively treat people to reduce anxiety disorders, he said.
By Rick Nauert PhD Senior News Editor Technology has provided researchers with physical evidence of how sleep deprivation can lead to anxiety. Investigators say their findings show that sleep loss markedly exaggerates the degree to which we anticipate impending emotional events. This overreaction often occurs among highly anxious people, making them especially vulnerable.
Experts say that two common features of anxiety disorders are sleep loss and an amplification of emotional response. Findings from this new study suggest that these features may not be independent of one another but may interact instead. University of California, Berkeley researchers used brain scanning on 18 healthy adults in two separate sessions, one after a normal night’s sleep and a second after a night of sleep deprivation.
During both sessions, participants were exposed to an emotional task that involved a period of anticipating a potentially negative experience (an unpleasant visual image) or a potentially benign experience (a neutral visual image). Functional magnetic resonance imaging (fMRI) showed that sleep deprivation significantly amplified the build-up of anticipatory activity in deep emotional brain centers, especially the amygdala — a part of the brain associated with responding to negative and unpleasant experiences.
Amazingly, in some of these emotional centers of the brain, sleep deprivation detrimentally triggered an increase in anticipatory reaction by more than 60 percent. In addition, the researchers found that the strength of this sleep deprivation effect was related to how naturally anxious the participants were.
People who were more anxious showed the greatest vulnerability to the aggravating effects of sleep deprivation. The results suggest that anxiety may significantly elevate the emotional dysfunction and risk associated with insufficient sleep. “Anticipation is a fundamental brain process, a common survival mechanism across numerous species,” said Andrea Goldstein, lead author of the study.
“Our results suggest that just one night of sleep loss significantly alters the optimal functioning of this essential brain process, especially among anxious individuals. This is perhaps never more relevant considering the continued erosion of sleep time that continues to occur across society.”
Source: American Academy of Sleep Medicine
By Charles Poladian | Sweaty palms and increased heart rate are just two examples of how anxiety can affect a person. In a new study, anxiety also affects how hard the brain works.
That important deadline or a big test may have the worrier inside of us panicking which increases stress, leading to those tell-tale signs of anxiety. For girls, anxiety may cause your brain to work harder, causing it to burn out and you to perform worse in the long run.
Using a simple electrode cap, the study, led by Jason Moser, PhD, from the Department of Psychology at Michigan State University, measured brain activity of 149 students completing a simple task.
The task involved identifying the middle letter of a five-letter sequence. The students, 79 female and 70 male, also filled out questionnaires about how much they worry. While performance was pretty much equal for male and female students, brain activity in girls who were worriers was higher than the other students.
Anxiety made the task more difficult for the girls to complete causing their brain to work harder. As the test increased in difficulty, and individuals were more prone to make mistakes, the females who were identified as anxious performed worse. The anxiety caused the female student’s brain to work overtime because it had to compete with distracting thoughts and worries in addition to completing the task. Over time, this could lead to the brain being overburdened, burning out and more likely to get something wrong.
This burdening of the brain could lead to many problems, including underachievement at school. Anxiety can affect school performance for males and females, not researchers who cite previous studies associating anxiety with difficulty in subjects like math. Using an electrode cap to measure brain activity could also help doctors diagnose anxiety disorders.
The reason for this increased brain activity may be due to a hormonal difference in males and females. Estrogen may play a role in increasing brain activity in females, note researchers. Estrogen has been show to affect dopamine, which could be stimulating parts of the frontal lobe that are involved with learning.
To help reduce anxiety, researchers recommend brain challenges to improve memory and writing out worries to help alleviate stress.
The study was published in the International Journal of Psychophysiology.