Anxiety and Stress

Anxiety is a sense of threat, consciously or unconsciously, either internally or externally. It alerts you to perceived trouble.

Anxiety symptoms will take a massive toll on the quality of your life, health, and relationships. For example, we know that prolonged anxiety releases massive amounts of cortisol into your blood over an extended period of time and begins to damage vital functions of organs. It also creates strengthened fear pathways in the brain and an overactive amygdala (the fear center of the brain associated with fight, flight, flee, freeze).

We take a biopsychosocial or holistic approach to treating anxiety. This means we take into consideration the role of physical health, diet, exercise, a healthy social life, sleep, and self-care.

In regards to types of anxiety disorder, it really clusters into a few different areas which have specific diagnoses. Anxiety also tends to occur in the context of other mental health disorders. We spend time making a proper assessment and diagnosis early in treatment, this is important to accurately target the specific issues you are facing.

For example, it would not be wise to target anxiety exclusively if the leading issue is best captured by a diagnosis of post-traumatic stress disorder (PTSD) or to mistake it for obsessive-compulsive disorder (OCD). Various conditions require different styles of therapy to be most effective.The DSM-5 of Diagnostic and Statistical Manual of Mental Disorders, 5th Edition is the gold standard of diagnosis used by all psychologists. It clinically identifies the major anxiety disorders with the help of research. The following are the most common anxiety disorders:

Generalized Anxiety Disorder (GAD) is a disorder characterized by excessive worry, it is worry on steroids. People complain of feeling chronically anxious about a wide range of issues (health, finances, relationships, work) and spend little time worry free. Freud coined the term “free floating anxiety” to describe the disorder as persistent, chronic, and often its source feeling unidentifiable. Worry simply moves from one focus to the next. Those with GAD complain of frequent headaches, gastrointestinal complaints, sleep trouble, fatigue, muscle tension and always feeling on edge. This disorder is relatively chronic until treated so most find that it has been around for quite some time.

Another common anxiety disorder is Social Anxiety Disorder, which is very different from GAD. Unlike GAD, SAD is specific and related only to social situations. The person likely becomes highly anxious, tense, and distressed around social triggers. A patient with this anxiety disorder fears being scrutinized in some way by others, being embarrassed, humiliated, or rejected. They find themselves planning what they might say in social situations, leaving events early or being preoccupied with anxious anticipation of future events.

Specific Phobias, a third type of anxiety disorder, works much in the same ways as the previous but is specific to an object or situation (e.g. spiders, elevators, heights). The specific stimulus is heavily avoided and there is typically a huge cost to the avoidance. To be diagnosed, the anxiety has to be out of proportion off the actual danger involved. 

Agoraphobia, a final common disorder, was translated from greek as “fear of the marketplace” represents a general sense of fright and anxiety about being in large, outdoor, public spaces (e.g. sporting events, public transit, standing in line and for some, simply being outside the home).

Many who suffer from the above also suffer from Panic Attacks. The difference between Panic Attacks and Anxiety Disorders is addressed in more detail in the following question. 

There is a difference between experiencing intense anxiety and a panic attack. Panic attacks are the experience of, as one patient stated, “being hit by lightning” or “feeling drugged.” They typically come on suddenly out of nowhere, they are extremely disorienting, and severe. Some report having Panic Attacks at the peak state of an anxious moment. People often report being “afraid that they are going crazy”, “having a heart attack”, or “about to die.” It is your body’s peak anxiety state before it begins to cool down and it is frightening. There is a sense of impending doom associated, rapid heart rate, sweating, trembling/shaking, shortness of breath, tightness in the throat, chills or hot flashes, lightheadedness, numbness, and most prominently a feeling of being detached from reality or dissociated from oneself. It is the most common mental health issue presenting to the Emergency Rooms because it is so often mistaken for a physical, medical event. 

Anxiety Disorders are diagnosed by a psychologist. Of all the types of therapists, we are the most trained in being able to effectively diagnose mental health issues. Within the first session or two you should have a solid working understanding of your diagnosis and the treatment approach. We even offer the option (at no cost) to complete a psychological evaluation digitally prior to your first session. However, we would never diagnose from this alone and any accurate diagnosis includes in-person clinical evaluation which is seamlessly embedded into the beginnings of therapy. Your questions about diagnosis are always welcomed and we take the time to explain your condition and collaborate with you on care. 

We think the best way to approach treating anxiety is integrating the wisdom of a variety of different techniques. We don’t have a one-size-fits-all model so we can speak in steps and stages but can address the underpinnings of what we think is important. We use a cognitive, psychodynamic, and mindfulness based treatment method that honors our patients unique type of anxiety, personal strengths, and personality style. Combining effective methods is often referred to as an “eclectic” approach and we think it works best to get anxiety under control in the quickest way possible. It is better to use multiple effective methods flexibly than use one rigidly implemented. Let me break down some of the language above. 

The cognitive or otherwise called cognitive behavioral therapy (CBT) model honors and examines one’s process of thought when it comes to anxiety. We want to help you understand how your thoughts, feelings, and behaviors are linked so that we can identify and come up with strategies to manage chains of maladaptive thinking. The psychodynamic component targets root origins of anxiety. This is your personal history with regards to anxiety. How it came to be your life, its role, its function in relationships, how it operated in early life and relationships, and how other feelings interact with and potentially drive anxiety upwards. We want to help heal early trauma, loss, and childhood instability. 

Our goal is to understand this with you so we aren’t just putting band-aids on the issue, unfortunately, a cognitive only approach can be just this without these other elements. We know, for example, that homes where certain feelings are not allowed often present as anxiety disorders later in life. The taboo feelings are often repressed unconsciously and appear as anxiety on the surface, particularly emotions like sadness, grief, and anger. Lastly, mindfulness based skills operate two-fold. One, to give you an immediate skill for relief when needed. There is a certain effective way to use mindfulness strategies specific for anxiety and we can help you understand and implement these. Second, it can help you create an entirely different relationship with your mind. To bear witness to thoughts, experience feelings fully, to allow them space, and to fundamentally change your relationship with your mind is key. Using all of these methods together is what we have found to be most effective in getting past anxiety entirely. 

We are not psychiatrists who prescribe anti-anxiety medication, but we are very familiar with the course of medications typically prescribed to those suffering from anxiety disorders. This is also not a substitute for a visit with a psychiatrist. Anxiety is tough to quell long-term with medications. 

Psychiatrists will typically start you off on some form of a selective serotonin reuptake inhibitor (SSRIs) antidepressant. These work on the neurotransmitter Serotonin and typically have an anti-anxiety component to them.They take about three to four weeks to kick in and are non-addictive, but do create dependence—you have to wean on and then wean off of them over the course of one to two weeks.Antidepressants in general do not make you euphoric and totally free of anxiety instantly but instead work more subtly. At low doses, they are relatively side effects free, and can at times be a helpful adjunct to therapy.When antidepressants work well, that’s actually when you want to double down in therapy so you don’t have to be dependent on the meds. It gives you a little breathing room to do the work. That’s the purpose of the medications, not to fix it once and for all long-term.Most psychiatrists will not want you to be on the drug forever, but rather use them as a way to get therapy moving. Once you have worked through the issues pertaining to your depression in therapy and feel the real change, we will work with your psychiatrist to titrate you off of the medications. 

At times, psychiatrists will provide other medications that target anxiety more directly but they are short-acting and not meant to be taken long-term. A safer option is typically a beta-blocker drug (e.g. propranolol) that blocks physical effects of an anxious mind (keeps heart rate low and red/flushed symptoms minimal). Essentially, the feeling of anxiety won’t go away but the physical symptoms of it are temporarily muted under the influence of the drug. It is not psychoactive so you won’t feel much different and it is relatively safe compared to other anxiety-specific medications. It is a helpful emergency use, non-addictive drug for those suffering from panic attacks.

On the more risky side, there are drugs in the benzodiazepine class. Some psychiatrists are more liberal at prescribing these medications. However, it is worth stopping and considering the risks before starting these treatments for anxiety. They are extremely psychoactive, carry a high risk of addiction and dependence, and have a rebound effect of anxiety when the drug wears off.We now know that long-term use of benzodiazepines is correlated with dementia or Alzheimer’s disease later in life.

Anxiety affects teens and young adults in very similar ways to the general adult population. In addition to those symptoms, you may see some other features common to teens and young adults. These include irritability, trouble concentrating in school, poor grades, social isolation, withdrawing from friends, associated depression, anger, and avoidance. Anxiety is unfortunately frequently mistaken for ADD or ADHD in teens.

If you are noticing these signs and symptoms it may be indicative of an underlying anxiety disorder. It is estimated that 31.9% of teens have had an anxiety disorder at one point in time (NIMH, 2021). 

Those who have a family history of anxiety or depression may be more at risk for developing an anxiety disorder. However, the underlying genetic mechanisms of anxiety disorders are not well understood.

In part, this is tricky because parents often provide both the genes and environment making it hard to clearly separate the two. Those with a history of trauma, loss, childhood instability, neglect, or chronic stress may also be more at risk.

Lastly, anxiety disorders appear more prevalent in women as compared to men. However, again, research is complicated because it may be that women are simply more likely to report symptoms and seek help as compared to men. 

When left untreated we know that fear networks in the brain continue to grow. What is once a kernel of anxiety, can quickly evolve into a diagnosable disorder.

Getting treatment as early as possible is key. Habits of mind, ineffective coping, and years of a revved-up central nervous system take longer to heal than one that is managed therapeutically earlier in life.

It is important not to wait if you are noticing signs and symptoms, early treatment could potentially change the trajectory of the condition and thus change the course of your life.

With teens and young adults, we will on occasion, reach out to the family with the cooperation and consent of the patient, to make changes in the family system. When everyone works together, therapy works best.