Anxiety Disorder

Everyone feels anxious or nervous from time to time. Anxiety is the normal response to anticipating stressful situations, and it serves a useful purpose: motivating us to avoid danger and preparing us to act in times of need. However, for people with anxiety disorders, the body’s fight-or-flight response has become overactive. Worry reaches into areas of life that should be anxiety-free, such as social interactions with friends. The nervousness and accompanying distress can make simple tasks challenging.

If you have trouble with anxiety, you’re not alone. The American Psychiatric Association reports that over 25 million Americans live with anxiety disorders, making them the most common type of emotional disorder. The Merck Manual Home Health Handbook puts the number even higher, at 15 percent of the adult population (over 36 million people).

What Are Symptoms of Anxiety Disorders?

Although there are different types of anxiety disorders, each with its own profile, they share a number of possible symptoms in common:

• Physical symptoms
• Racing heartbeat
• Shortness of breath
• Dizziness or lightheadedness
• Trembling or shaking
• Sweatiness
• Butterflies in the stomach
• Jumpiness
• Tightness in the chest
• Insomnia or difficulty sleeping
• Nausea
• Mental symptoms
• Intense anxiety, nervousness, or fear
• Panic attacks
• Nightmares
• Dread of anxiety-triggering situations
• Feeling like situations are out of control
• Invasive feelings of worry
• Intrusive memories of painful past events
• Irritability or outbursts of anger
• Inability to stop thinking troublesome thoughts
• Uncontrollable racing thoughts

Behavioral symptoms

• Avoiding situations, places, objects, or people that might trigger panic or anxiety
• Compulsively completing tasks to stave off feelings that something might go wrong (such as double-checking all the locks in the house before going to sleep at night)

Generalized Anxiety Disorder (GAD)

Types of Anxiety Disorders

Generalized anxiety disorder (GAD) is severe, chronic anxiety that interferes with day-to-day life, lasting for at least six months. It can present as constant nervousness or worrying to the point of obsession. The fears might seem dominant or out of control. Worries might revolve around any number of things going on in a person’s life, like work or school obligations, money, family, health problems, errands, or chores. The anxiety can cause:

• Insomnia and difficulty sleeping
• Irritation or agitation
• Weakness or shakiness
• Muscle aches or tension
• Distress
• Headaches

According to the Anxiety and Depression Association of America (ADAA), almost seven million adults will live with GAD in any given year.

Obsessive-Compulsive Disorder (OCD)

Obsessive-compulsive disorder (OCD) causes people to experience persistent and unwanted thoughts that they just can’t manage to let go of, called obsessions. These obsessions can drive them to repeatedly perform specific routines or behaviors, called compulsions, in an attempt to soothe the anxiety. People with OCD know that their obsessions and compulsions might not make sense but feel like they have to act anyway.

Other symptoms of OCD can include:

• Excess concern regarding hygiene, cleanliness, germs, dirt, or contamination
• Obsessive interest in order, symmetry, or completion
• Refusing to throw away minor objects of little value
• Preoccupation with others’ safety or worry of causing accidental harm to others
• Repeating certain phrases or actions
• Checking and re-checking

According to Dialogues in Clinical Neuroscience, about one to three percent of the adult population lives with OCD.

Post-Traumatic Stress Disorder

Post-traumatic stress disorder (PTSD) occurs after a person survives a traumatic event or series of events such as combat experience, sexual assault, the death of a loved one, or a natural disaster. Although it’s normal to have a stress response to trauma (such as having difficulty sleeping, anxiety about the topic of the trauma, distress, or depression), this response usually fades within a few weeks or months.

If it doesn’t, the person may have PTSD. People with PTSD can experience:

• Recurring nightmares about the trauma
• Flashbacks (intrusive, overwhelming memories of the trauma)
• Panic attacks
• Emotional numbness or detachment
• Avoidance of people, places, or things associated with the trauma
• Difficulty sleeping or insomnia
• Difficulty concentrating or remembering details
• Irritation or agitation at little or no provocation

According to the ADAA, 7.7 million American adults live with PTSD, and women are twice as likely as men to develop the disorder. The Department of Veterans Affairs(VA) reports that 3.6 percent of men and 9.7 percent of women will develop PTSD within their lifetimes.

• Social anxiety disorder/social phobia is the fear of being judged, examined, or scrutinized by others in social situations. People with social anxiety disorder may be terrified of being embarrassed or humiliated. While most people are nervous about things like public speaking, social anxiety disorder can make it a real struggle to complete regular tasks such as going to work or school, interviewing for jobs, and maintaining friendships and relationships. The ADAA says that about 15 million Americans age 18 or older have social anxiety disorder, and that over a third of them live with their symptoms for over 10 years before they get help.
• Panic disorder can cause spontaneous, unwarranted panic attacks. People who experience panic attacks might develop a great deal of anxiety about the idea of getting a panic attack in public, such as at work or in front of friends. In the case of agoraphobia, this can cause the person to stop going places where they’ve previously had a panic attack, or to avoid public places without easy escape routes, like trains or arenas. They may find themselves living their lives along fixed paths or sticking to safe locations, frequently concerned about the next attack. According to the ADAA, six million American adults meet the criteria for panic disorder each year, and about a third of them also have agoraphobia.
• Specific phobias are excessive and irrational fears of specific things that trigger anxiety and panic attacks.

  Common phobias include fear of:

  • Snakes, spiders, or dogs
  • Enclosed spaces
  • Blood or injections
  • Dental procedures
  • Heights
  • Travel (especially flying)

According to NIMH, 12.5 percent of adults experience a specific phobia in their lifetimes.

Treatment for Anxiety Disorders

Depending on the nature of the anxiety disorder, different types of therapy might be effective. For example, a war veteran with PTSD might find the peer support of group therapy helpful, while someone who is phobic of heights might get the most benefit from exposure therapy. When treating anxiety, it’s important to find a specialist who offers treatments that are right for you.

• Pharmacotherapy offers a range of medications that can help manage the symptoms of anxiety. Medications are best used in combination with psychotherapy, as they can stabilize a client and make him or her receptive to treatment.
  • Selective serotonin reuptake inhibitors (SSRIs) are mainly known as antidepressants, but many of them also help reduce anxiety. Common SSRIs include Celexa (citalopram), Lexapro (escitalopram), Prozac (fluoxetine), Paxil (paroxetine), and Zoloft (sertraline). Serotonin-norepinephrine reuptake inhibitors (SNRIs) like Effexor (venlafaxine) and Cymbalta (duloxetine) are also effective.
  • Tricyclic antidepressants also treat anxiety, but they are less commonly used due to unpleasant side effects. Tricyclics include Elavil (amitriptyline), Sensoval/Pamelor/Aventyl (nortriptyline), and Tofranil (imipramine).
  • Benzodiazepines are also known as tranquilizers and have powerful sedating and relaxing effects. They’re useful for stopping a panic attack and can neutralize anxiety. However, using them in the long term builds up tolerance and can lead to dependence and abuse. Common benzodiazepines include Xanax (alprazolam), Klonopin (clonazepam), Valium (diazepam), and Ativan (lorazepam).
  • Sleep aids like Ambien (zolpidem) and Lunesta (eszopiclone) can help treat insomnia.
  • Beta-blockers like propranolol can prevent the body’s fight-or-flight system from kicking in, helping therapy to work better. A study published in Biological Psychology found that propranolol was useful for treating PTSD.
  • Buspirone is an anti-anxiety medication that can help treat GAD, says an article in the American Family Physician. It can take three or four weeks to start taking effect.

• Cognitive-Behavioral Therapy (CBT) is the top recommended type of psychotherapy for anxiety disorders, according to NIMH and the American Psychological Association. The cognitive aspect helps people alter the thought patterns that support their worries and fears, cutting the feedback cycle, and the behavioral aspect helps people learn to deal with anxiety-provoking circumstances in new ways.
• Exposure therapy is a form of CBT that involves gradually exposing people to the things they’re afraid of so they can learn that their fears are unsubstantiated.
  • For someone with a specific phobia of snakes, this might involve sessions of getting closer and closer to first pictures of snakes, then videos of snakes, and then a live snake.
  • For someone with PTSD, this might mean writing down the story of a traumatic memory, then reading and rereading it to gradually become desensitized to it.
  • For someone with OCD, this might mean spending increasing amounts of time after touching something dirty before washing their hands.
  • For someone with social anxiety, this might mean entering into safe social situations and seeing how people react – usually, far less judgmentally than the person feared.
• Dialectical Behavioral Therapy (DBT) is a modified version of CBT that teaches people how to tolerate extreme or distressing emotions, such as self-criticism or the urge toward self-destructive behaviors.
• Cognitive processing/restructuring therapy (CPT/CRT) helps people with PTSD sort through their memories of traumatic events. People may blame themselves for what happened to them or feel stuck in their thoughts circling the trauma. CPT gives the person the opportunity to decide how they want to feel about their trauma, and then teaches the skills to change their beliefs to match. The VA reports that CPT is effective for PTSD.
• Eye-movement desensitization and reprocessing (EMDR) uses a series of induced eye movements, taps to the limbs, or auditory tones to disrupt the faulty neural circuitry underlying PTSD. This gives the person the opportunity to address and process their traumatic memories without fear circuitry activating and getting in the way of healing.
• Support groups or 12-Step groups offer people a supportive group of peers while they are getting other help to treat an anxiety disorder. It can be easier to deal with anxiety when you know you’re not alone.
• Complementary therapy consists of treatments that are not meant to replace medication or psychotherapy, but instead work alongside them.
  • Mindfulness incorporates practices from Buddhism and yoga to teach “nonjudgmental awareness of the present,” according to a meta-analysis published in the Journal of Consulting and Clinical Psychology. It teaches the practitioner how to be aware of their sensations, thoughts, emotions, and feelings without being overwhelmed or controlled by them. These practices can help reduce the symptoms of anxiety, the analysis found.
  • Exercise helps reduce anxiety, according to a review article in the Journal of Neural Transmission. It causes the brain to release chemicals that help regulate the body’s stress system, reducing the fight-or-flight reaction. Going outside to exercise can also act as a form of exposure therapy for people with panic disorder, PTSD, social anxiety, and other anxiety disorders with elements of avoiding the public.
• Dual Diagnosis treatment is appropriate for people who have been diagnosed with both an anxiety disorder and a substance abuse disorder. Many of the treatments for the two types of disorders are the same – for example, learning techniques to deal with stress in a healthy manner or building new behavior patterns that don’t provoke anxiety.

A Dual Diagnosis

When you consider how anxiety works in the brain, it can be easy to see why people with anxiety disorders might try to use substances to help feel better. Drugs like alcohol, benzodiazepines, opiates, and cigarettes all help soothe the body’s fight-or-flight system, which is overactive in anxious people. However, using substances to treat anxiety without a doctor’s recommendation can be dangerous and can lead to patterns of drug abuse.

A study in JAMA Psychiatry of over 43,000 people found that people with anxiety disorders were over twice as likely to have alcohol use disorder as well. A review in the American Journal on Addictions found that 30 to 59 percent of women who live with substance abuse disorder also had PTSD, about two or three times the prevalence seen among men. According to the VA, over 20 percent of veterans with PTSD also have substance use disorder, and almost a third of veterans who seek treatment for substance use disorders also have PTSD.

At Black Bear Lodge, our expert therapists specialize in treating Dual Diagnosis patients. We can work with you to develop a treatment program that addresses your unique needs. Fighting anxiety can be an incredible struggle, but hope is within reach. We can help – get in touch today at 706-909-9811 to learn more.

Panic Disorder

Panic disorders are in the larger class of anxiety disorders, which are mental health disorders defined by the feelings of anxiety and fear that sufferers experience. Other conditions under the umbrella of anxiety disorders are generalized anxiety disorders, obsessive-compulsive disorder, post-traumatic stress disorder, and separation anxiety, among others.

Signs of Panic Disorder

A patient with panic disorder experiences uncontrollable, unreasonable and unexpected sensations of fear that usually last for around 10 minutes but can be over in 60 seconds or continue until someone provides help. Individually, these episodes are known as panic attacks. The fear is usually based in the worry of something bad happening, something going wrong, or the patient losing control of his or her life, even when there is no real danger. In fact, one of the distinguishing characteristics of panic disorder is that the panic has to be disproportionate to the situation – a relatively minor incident can trigger a full-blown panic attack.

In addition to the above, symptoms of panic disorder can include:

• Rapid heartbeat
• Sweating
• Dizziness
• Nausea/vomiting
• Stomach/chest pain

According to PsychCentral, if the symptoms and altered behavior (avoidance and anticipatory anxiety) are in place for a month, then this might be a sign of a panic disorder.

Panic disorder can be so debilitating that people with the condition can actively dread the possibility of experiencing another panic attack, to the point that they go out of their way to avoid the people and places they fear may trigger an attack. The anticipatory anxiety of a panic attack can create problems in and of itself, as the patient may resort to never leaving his or her home, or may withdraw from activities, hobbies, and social engagements for fear of doing anything or being anywhere where their panic disorder might set in. The National Institute of Mental Health estimates that about 33 percent of people with panic disorder become shut-ins.

Panic disorder is so common that the Anxiety and Depression Association of America estimates that around six million Americans experience panic attacks in a year. Twice as many women develop panic disorder as men, possibly due to hormonal differences that may be exacerbated by certain medications and lifestyles.

Panic Disorder and Drugs and Alcohol

The problem of panic disorder can be so debilitating that patients turn to drugs or alcohol in an attempt to self-medicate – to make themselves feel better about their situation, or to work up the courage to overcome their anticipatory anxiety. Unfortunately, using controlled substances in this way can lead to an unhealthy addiction to them, compounding the problems caused by the initial panic disorder.

Furthermore, the National Alliance on Mental Illness warns that drugs and alcohol might be triggers for panic disorder.

How Can Panic Disorder Be Treated?

Treating panic disorder usually has two approaches – one is with a course of medication, like the administration of selective serotonin reuptake inhibitors (Prozac, Paxil, Zoloft, etc.) for alleviating anxiety and depression. Benzodiazepines, like Xanax, are another popular pharmaceutical option; they relax muscles and create a mildly sedating and anti-anxiety effect in patients.

The second arm of treating panic disorder is psychotherapy, when a mental health professional works with the patient on breaking down the mechanics of a panic attack. This might involve the patient learning how to control their thoughts and behaviors, or to develop the tools to cope with the feelings of anxiety and tension that predict a panic attack, so that they are no longer at the mercy of the disorder.

If you are one of the six million people who struggle with panic disorder and the fear of losing control in response to a stressful event, you don’t have to resign yourself to a lifetime of fear. We can help you take control of your life back. Please call us today at 706-909-9811 to find out how Black Bear Lodge can help you.

Phobias

Phobias are a very natural part of life – many people have them – so it can be surprising to think of phobias as a form of anxiety disorder.

Because it’s true: even the most common phobias (fear of the dark, fear of spiders, fear of heights, etc.) can trigger the familiar signs of anxiety and panic attacks in people, ranging from mere avoidance to abject fear. But how do phobias work? Why do we have them? How can we get over them? Is it even possible to do that?

Defining “Phobias”

While there’s nothing wrong with being scared of certain things, what defines a phobia as an anxiety disorder is that the fear is often unwarranted and irrational. The American Psychiatric Association explains that people with phobias are often aware of this, but, as is true of any anxiety disorder, they cannot control the fear and horror that grips them when they are exposed to their phobia.

Phobias can fall into a couple of general categories. Chief among them are specific phobias, involving an extreme fear based on something specific:

• Fear of a particular animal (like spiders)
• Fear of a particular social situation (like a job interview)
• Fear of a particular place
• Fear of a particular activity (like speaking in public)

Then there is agoraphobia, where a person is afraid of being in a situation where there is no perceived method of escape. The root of that fear is that if something bad happens, the person is not able to leave the area. This is why some people are afraid of elevators or airplane cabins, or why they fear being in crowded areas. Severe cases of agoraphobia can render a person incapable of leaving their own home.

What Makes a Phobia an Anxiety Disorder?

Phobias are incredibly common – it is estimated that over 50 million people in the United States have a phobia – but when a phobia directly or indirectly causes a disruption in a person’s life, this is when the issue needs to be addressed. For example, some people go to extreme lengths to avoid whatever their phobia is, like refusing to leave home, as stated above. This can result in a significant deterioration in quality of life, if social interactions, job and academic performance, and hobbies and activities are ignored in favor of avoiding the source of the phobia.

Also, by their nature of being anxiety disorders, phobias can lead to, or exacerbate, the use of dangerous drugs (and dangerous levels of alcohol use). The National Alliance on Mental Illness says that sufferers use drugs or alcohol “to decrease the fear and anxiety associated with their illness.” In reality, however, this use of controlled substances can lead to addiction and further mental health concerns.

How Do Phobias Form? What Can Be Done About Them?

There are a number of theories to explain how and why phobias form. For example, a traumatic incident in childhood might create a lifelong negative association – a child being bitten by a dog becomes an adult with a dislike of dogs and a fear of the breed of dog that bit him or her. Some people experience panic attacks in certain situations, and thus develop a phobia of being in that situation in case the panic attack happens again. If they find themselves in that situation, they have an adverse reaction because of their phobia, not because of the first panic attack.

However a phobia forms, and whatever the phobia is, there’s always hope. If you find yourself feeling trapped and helpless because of your phobia, call us here at Black Bear Lodge at 706-909-9811. There are various medication options for addressing the anxiety caused by phobias and psychotherapy options for learning how to control your thoughts and behavior when confronted with the source of your phobia. Whatever your needs are, there is a solution, and we want to help you find it.

Social Anxiety Disorder

People with social anxiety disorder fear doing something embarrassing in public, and/or the scrutiny and judgment of strangers, so they completely avoid social interactions or drastically limit their exposure to social activities. What makes this kind of behavior a concern is that someone with social anxiety disorder will allow the quality of their life to decline if it means that their anxiety will be assuaged; that is, they will let their social life deteriorate, they will let their job and academic performance recede, and they may never leave their house, if it means that this protects them from what their social anxiety disorder makes them fear.

Scope and Symptoms of Social Anxiety Disorder

People with social anxiety disorder know that there is no logical reason to fear simple social interactions, but they are helpless to control or prevent the dread and anxiety that comes whenever they are in a trigger situation, explains the National Institute of Mental Health. For that reason, they may feel the tension and anxiety start to develop even weeks in advance of the date of a social interaction, or for however long it takes to work up the nerve to go out. Some sufferers of social anxiety disorder experience symptoms for almost every conceivable social interaction; others may experience symptoms for specific situations. For example, giving a speech causes no discomfort, but going out on a date is a source of significant fear and stress.

Because of this scope, the NIH estimates that around 15 million Americans have some form of social anxiety disorder. Perhaps the very nature of the condition prevents people from seeking help for it – the Anxiety and Depression Association of America reports that 36 percent of people who have social anxiety disorder have symptoms for 10 years or more before finally seeking help.

As with most types of anxiety disorders, there is a high possibility of developing an addiction to harmful drugs and alcohol. In social anxiety disorder, a person might resort to using stimulants to work up the courage to go out, or relaxants to calm their nerves about going to a public place. But using recreational substances (or even prescribed drugs, but without medical supervision) to deal with the effects of social anxiety disorder can create a number of psychological problems, some of which might even compound the anxiety of social anxiety disorder.

The symptoms of social anxiety disorder can include:

• Avoidance of places where the person fears they will be judged or humiliated
• Inability to enjoy social experiences, like going to a movie or public event
• Difficulty making friends and connections
• Physical reactions (sweating, trembling, upset stomach, etc.) when having to socially interact

The anxiety can become so severe that it leads to a full-blown panic attack, which, while being an emergency on its own, reinforces the social anxiety.

Treating Social Anxiety Disorder

The Mayo Clinic explains that, like most anxiety disorders, treating social anxiety disorder has two approaches: medicine and psychotherapy. Medicine often involves the prescription of selective serotonin reuptake inhibitors, which are a class of antidepressants used for their effectiveness and limited side effects. They work by preventing the brain from reabsorbing serotonin, a neurotransmitter that is associated with feelings of positivity and happiness. Other forms of medication can include benzodiazepines, known for their powerful sedative and relaxant qualities.

With psychotherapy, the patient will talk with a doctor about understanding the thoughts and feelings behind social anxiety disorder. This might mean learning how to think and behave in healthier and more positive ways to counteract the onset of social anxiety. Psychotherapy can also include programs like carefully exposing the patient to the situations that they fear the most, to show them that no harm will come to them, or that the harm is minimal; or including friends and family in the therapy, to provide education and insight into what social anxiety disorder entails for the patient.

Social anxiety disorder can be very difficult to live with, but we want you to know that you don’t have to live with it. Starting the process of treatment can begin with a single phone call to 706-909-9811 to talk with one of our admissions coordinators, who are standing by to give you all the information you need.