Psychiatric Associates

Anxiety Disorders

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What is Anxiety?

       Anxiety is a normal reaction to stress. It helps you deal with a tense situation at work, study harder for an exam, or keep focused on an important speech. In general, it helps you cope. But when it becomes excessive, inappropriate, or irrational it can be disabling. People who are anxious typically have recurring disturbing thoughts or concerns, avoid certain situations out of worry, and have physical symptoms such as sweating, trembling, dizziness, a rapid heartbeat, or increased blood pressure. Anxiety Disorders affect about 40 million American adults (about 18% of that population) in any given year. Unlike the relatively mild, brief anxiety caused by a stressful event such as speaking in public or going on a first date, anxiety disorders last at least six months and can get worse if not treated.

What types of Anxiety Disorders are there?

       Anxiety Disorders include:
  • Panic Disorder — sudden, uncontrollable attacks of terror that cause heart palpitations, dizziness, shortness of breath, and the feeling that things are out of control;
  • Agoraphobia — a fear of leaving home which develops in some people with Panic Disorder;
  • Specific Phobia — irrational fear and deliberate avoidance of something that causes anxiety or a panic attack;
  • Social Phobia — persistent fear of one or more situations in which you believe you’re being observed or judged by others;
  • Obsessive-Compulsive Disorder (OCD) — repeated, disturbing, and unwelcome thoughts that cause anxiety, often accompanied by ritualized behavior that’s intended to relieve the anxiety;
  • Posttraumatic Stress Disorder (PTSD) — recurring nightmares and/or flashbacks and other symptoms of psychological and physiological distress caused when someone experiences or sees a severely upsetting or traumatic event;
  • Acute Stress Disorder (ASD) — dissociative symptoms and other symptoms of psychological and physiological distress caused when someone experiences or sees a severely upsetting or traumatic event, not lasting as long as PTSD;
  • Generalized Anxiety Disorder (GAD) — excessive anxiety and worry that last for at least six months and are accompanied by physical and behavioral symptoms.
[Note: Clicking on the underlined disorders will take you to in-depth articles about each disorder by Dr. Hranilovich.]
 
What are the symptoms of these Anxiety Disorders?

       Panic Disorder is characterized by Panic Attacks that seem to come out of nowhere. Panic Attacks are sudden attacks of terror accompanied by at least four of the following:
  • an irregular heart beat, a pounding heart, or accelerated heart rate;
  • sweating;
  • trembling or shaking;
  • sensations of shortness of breath or smothering;
  • a feeling of choking;
  • chest pain or discomfort;
  • nausea or abdominal distress;
  • feeling dizzy, unsteady, lightheaded, or faint;
  • derealization (feelings of unreality) or depersonalization (feelings of being detached from oneself);
  • fear of losing control or going crazy;
  • fear of dying;
  • paresthesias (numbness or tingling sensations, especially in the hands, feet, and/or face);
  • and chills or hot flushes.
       An attack usually peaks within 10 minutes, but some symptoms may last much longer. People having Panic Attacks sometimes believe that they're having heart attacks and go to an Emergency Room, where they’re often misdiagnosed as having a medical condition or told that it’s all in their heads. Panic Attacks can occur anywhere from a few times a year to several times a day at any time, even during sleep. People with Panic Disorder can't predict when or where an attack will occur, and spend their time worrying about having another attack.

       Agoraphobia, which often accompanies Panic Disorder but can also occur by itself, is characterized by fear of being alone in public places, especially places from which escape would be difficult if the person had a Panic Attack. Agoraphobia can be the most disabling of the Phobias, since it may significantly interfere with a person’s ability to function outside the home. Agoraphobia sufferers prefer to be accompanied by a friend, family member, or other trusted companion in such places as busy streets; crowded stores; closed-in spaces such as tunnels, bridges, and elevators; and closed-in vehicles such as subways, buses, and airplanes. They may insist on being accompanied every time that they leave home. People with severe Agoraphobia may simply refuse to leave home at all.
       Specific Phobias are characterized by an intense, irrational fear of something that poses little or no actual danger.While adults with phobias realize that their fears are irrational, they often find that facing or even thinking about facing their fears brings on anxiety or even a Panic Attack. In decreasing order of commonness, sufferers of Specific Phobias fear animals, storms, heights, illness, injury, and death. If the feared situation is easy to avoid, people with Specific Phobias may not seek help; if it's not, they can become disabled and are then more likely to seek help.

       There are five types of Specific Phobias: Animal Type; Natural Environment Type; Blood, Injection, and Injury Type; Situational Type; and Other Type.
  • Animal Type is characterized by fear of animals or insects. It generally starts in childhood.
  • Natural Environment Type is characterized by fear of storms and other weather phenomena, heights, or water. It, too, generally starts in childhood.
  • Blood, Injection, and Injury Type is characterized by fear of having blood drawn, receiving immunizations, having surgery, or even seeing blood or an injury. It tends to run in families and to cause fainting.
  • Situational Type is characterized by fear of specific environments or activities such as using public transportation, traveling in tunnels or on bridges, flying in an airplane, driving or being a passenger in a vehicle, or being in a small enclosed space such as an elevator. It’s most common during childhood and the mid-twenties.
  • Other Type is characterized by fear of anything else, such as choking, vomiting, germs, or clowns.
       Social Phobia (Social Anxiety Disorder) is characterized by overwhelming anxiety and excessive self-consciousness in everyday social situations. People with Social Phobia have an intense, persistent, and chronic fear of being watched and judged by others and of doing things that might embarrass them. They might worry for days, weeks, or even months before an event is to occur. Their fears can become so severe that they can't work, go to school, or engage in other ordinary activities simply because these activities involve other people. While many people with Social Phobia realize that their fears are excessive or inappropriate, they're unable to overcome them. Even if they manage to confront their fears and be around others, they're usually very anxious beforehand, are intensely uncomfortable throughout the encounter, and for hours afterward worry about how they were judged. Social Phobia can be limited to one situation, such as talking to others, eating or drinking in public, or writing in public (paying for something with a check or writing on a blackboard), or may be so broad that the person experiences fear around almost everyone except family. Physical symptoms that often accompany Social Phobia include:
  • blushing;
  • profuse sweating;
  • trembling;
  • nausea;
  • and difficulty talking.
       Obsessive-Compulsive Disorder (OCD) is characterized by persistent, upsetting thoughts (obsessive thoughts or obsessions) and/or rituals (compulsive behaviors or compulsions) intended to control the anxiety that these thoughts produce. Most of the time, however, the rituals end up controlling the person. Common obsessions include:
  • repeated fears of contamination (becoming infected by shaking hands);
  • repeated doubts ( wondering whether or not you hurt someone in a traffic accident or left a door unlocked);
  • a need to have things in a particular order (intense distress when objects are disordered or messy;
  • aggressive or horrific impulses (to hurt your child or to shout an obscenity in church);
  • and sexual imagery (recurrent pornographic images).
       Common compulsions include both physical actions and mental actions. Physical actions include:
  • hand washing (a symptom of fear of contamination);
  • ordering (“A place for everything and everything in its place.”);
  • checking (making sure that the stove is turned off, the doors are locked, the iron is turned off, etc.);
  • repeatedly asking for reassurance (“You still love me, don’t you?”);
  • and performing sequences of certain actions (flipping the light switch on and off a certain number of times when entering and/or leaving a room).
       Mental actions include:
  • praying (praying constantly or saying different prayers for different times of day or situations);
  • counting (making sure that certain “bad” numbers are avoided, or doing things by threes, fours, etc.);
  • and repeating words silently to yourself (checking to make sure that you didn’t say the wrong thing or say something incorrectly).
       A symptom that’s getting a great deal of media attention at present is hoarding (an inability to discard worn-out or worthless objects even when they have no sentimental value). People with OCD perform these compulsions even though doing so takes so long that it interferes with daily life and is extremely distressing. Symptoms may come, go, get better, or get worse. If they become severe, they can and often do interfere with the person’s ability to work or to carry out responsibilities.

       Posttraumatic Stress Disorder (PTSD) develops in reaction to seeing or living through a dangerous event involving someone’s death or the threat or risk of death or serious injury to you or someone else and which causes intense fear, helplessness, or horror. Symptoms usually begin within three months of the event but can begin years later. The disorder was first recognized in veterans of the Vietnam War but is now recognized as also happening to people involved in other traumatic experiences, such as:
  • being mugged, raped, tortured, kidnapped, held captive, sexually assaulted, and/or physically assaulted;
  • being in a motor vehicle accident (MVA), train wreck, ship sinking, and/or plane crash;
  • being in an explosion and/or a fire;
  • or being in a natural disaster such as a hurricane, tornado, flood, and/or earthquake
       PTSD is characterized by three categories of symptoms: Re-experiencing, Avoidance, and Hyperarousal. Re-experiencing symptoms include:
  • frightening memories of what happened;
  • unpleasant dreams or nightmares about what happened that may awaken the person or cause the person to speak, cry out, or strike out while asleep;
  • “flashbacks” -- reliving what happened over and over, including physical symptoms like a racing heart or sweating;
  • crying or becoming angry or enraged by thinking about, remembering, or being reminded of what happened;
  • and increased pulse and respiration rates, sweating, trembling or shaking, nausea or abdominal distress and similar anxiety symptoms in reaction to thinking about, remembering, or being reminded of what happened.
       Avoidance symptoms include:
  • efforts to avoid thoughts, feelings, or conversations associated with what happened;
  • efforts to avoid activities, places, or people that bring up memories of what happened;
  • an inability to recall an important aspect of what happened;
  • markedly diminished interest or participation in significant activities;
  • a feeling of detachment or estrangement from others;
  • being unable to experience normalemotions;
  • and not expecting to have a career, marriage, children, or a normal life span.
       Finally, Hyperarousal symptoms include:
  • difficulty falling or staying asleep, which may be due to recurrent nightmares about what happened;
  • irritability or outbursts of anger;
  • difficulty concentrating;
  • being constantly on edge;
  • and an exaggerated startle response.
       Acute Stress Disorder develops the same way that PTSD does. The symptoms begin within four weeks of the event and last between two days and four weeks, and include three or more of the following dissociative symptoms:
  • a subjective sense of numbing, detachment, or the absence of emotional responses;
  • a reduced awareness of what’s going on around you (being in a daze);
  • a feeling of unreality;
  • a feeling of being detached from yourself;
  • and an inability to recall an important aspects of what happened.
       It’s also characterized by:
  • recurrent images, thoughts, dreams, or illusions about what happened; flashback episodes or a sense of reliving what happened; and/or distress on exposure to reminders of what happened;
  • avoiding thoughts, feelings, conversations, activities, places, and/or people associated with what happened;
  • and difficulty sleeping, irritability, poor concentration, edginess, exaggerated startle response, and/or restlessness or agitation.
       Generalized Anxiety Disorder (GAD) consists of exaggerated worry and tension, even though realistically there’s little or nothing to worry about. People with GAD anticipate the worst and are overly concerned about health issues, money/finances, family problems, or difficulties at work or school. Sometimes just the thought of getting through the day produces anxiety. It’s what most people mean when they think of a “worry wart” or “anxiety neurotic” and is exemplified by Charlie Brown of the “Peanuts” gang. People with GAD can’t seem to get rid of their concerns, even though they usually realize that their anxiety is excessive and inappropriate. Those with mild GAD can usually function socially and hold down a job or go to school. Those with moderate to severe GAD have increasing difficulty carrying out the simplest daily activities and responsibilities. GAD is characterized by difficulty controlling the worry and by three or more of the following symptoms:
  • restlessness or feeling keyed up or on edge;
  • being easily fatigued;
  • difficulty concentrating or having your mind go blank;
  • irritability;
  • muscle tension;
  • and sleep disturbance, such as difficulty falling or staying asleep and/or restless unsatisfying sleep.
What disorders often accompany Anxiety Disorder?

       Anxiety Disorders commonly occur along with other mental or physical illnesses, including alcohol or substance abuse, which may mask anxiety symptoms or make them worse. In some cases, these other illnesses need to be treated before a person will respond to treatment for the Anxiety Disorder.
 
       Panic Disorder is commonly accompanied by any of a number of medical symptoms and conditions, including but not limited to dizziness, cardiac arrhythmias, hyperthyroidism, asthma, chronic obstructive pulmonary disease (COPD), and irritable bowel syndrome (IBS). Mitral valve prolapse and thyroid disease are more common among individuals with Panic Disorder. Other Anxiety Disorders are also common, especially in those with more severe symptoms. Social Phobia and GAD have been reported in 15% to 30% of those with Panic Disorder, Specific Phobia in 2% to 20%, and OCD in up to 10%.

       Agoraphobia is sometimes present in individuals with certain general medical conditions who avoid certain situations due to realistic concerns about being incapacitated or being embarrassed. These individuals aren’t diagnosed with Agoraphobia unless the fear or avoidance is clearly excessive.

       Specific Phobias, depending on type, can be associated with certain medical conditions. About 75% of individuals with Blood-Injection-Injury Type report a history of fainting. Certain general medical conditions may be worsened as a consequence of phobic avoidance. For example, Blood-Injection-Injury Type may have a negative impact on your dental or physical health if you avoid necessary medical care. Similarly, fear of choking may have a negative impact on your health if you limit your food intake to things that are easy to swallow but nutritionally incomplete, or if you refuse to swallow medications. Other Anxiety Disorders, Mood Disorders, and Substance-Related Disorders are also common. From 50% to 80% of people diagnosed with a Specific Phobia are also diagnosed with another Anxiety Disorder.

       Social Phobia doesn’t seem to be associated with any general or specific medical conditions. However, it may be associated with other Anxiety Disorders, Mood Disorders, Substance-Related Disorders, and Bulimia Nervosa (an Eating Disorder), and it’s frequently associated with Avoidant Personality Disorder (a pattern of social inhibition, feelings of inadequacy, and hypersensitivity to criticism).

       Obsessive-Compulsive Disorder does not seem to be associated with any general or specific medical conditions in adults, although excessive hand-washing in those with a fear of contamination may cause skin problems. OCD in adults is sometimes associated with Major Depressive Disorder, other Anxiety Disorders, Eating Disorders, and some Personality Disorders. In children, it’s sometimes associated with Learning Disorders and Disruptive Behavior Disorders. From 35% to 50% of children and adults with Tourette’s Disorder also suffer from OCD, although only 5% to 7% of those with OCD also suffer from Tourette’s. Childhood onset of OCD is sometimes associated with Group A beta-hemolytic streptococcal infection (scarlet fever and “strep throat”).

       Posttraumatic Stress Disorder may be associated with increased rates of physical symptoms and, possibly, general medical conditions. It’s associated with increased rates of Major Depressive Disorder, Substance-Related Disorders, other Anxiety Disorders, and Bipolar Disorder.

What causes Anxiety Disorders?

       There's no single cause for Anxiety Disorders. Rather, they most likely results from a combination of genetic, biochemical, environmental, and psychological factors. Anxiety Disorders are disorders of the brain. Brain-imaging scans such as magnetic resonance imaging (MRI) have shown that the parts of the brain responsible for regulating mood, thought, sleep, appetite, and behavior function abnormally in anxious people. In addition, important neurotransmitters (chemical messengers) are out of balance. This knowledge doesn't explain WHY people become anxious, however.

       Some Anxiety Disorders appear to run in families, suggesting a genetic component. Anxiety Disorders also occurs in people without family histories of anxiety, however. The probability that anyone will experience an Anxiety Disorder results from the interaction between multiple genes and environmental or other factors. In addition, trauma, the loss of a loved one, a difficult relationship, or any other significantly stressful situation may trigger an Anxiety Disorder. Subsequent episodes of anxiety may not have an identifiable trigger, though.

How are Anxiety Disorders diagnosed?

       Even the most severe Anxiety Disorders are highly treatable. As is true of most medical and psychological disorders, the earlier that treatment begins the more effective it is and the higher the likelihood that recurrences can be prevented.

       The first step toward getting help is to see your Primary Care Provider (PCP), the medical provider whom you see for other disorders. Certain medications and medical conditions can cause the same symptoms as Anxiety Disorders. Your PCP can rule out these conditions by conducting a physical examination, asking questions, and/or ordering lab tests. If medications and medical conditions can be ruled out, your PCP will then prescribe an appropriate medication and/or refer you to a mental health professional for further evaluation.

       A mental health professional will conduct a complete diagnostic evaluation, including a discussion of any family history of Anxiety Disorders and other psychological disorders and a complete history of symptoms. This history will include when your anxiety started; how long you've been anxious; how severely anxious you are; whether or not you've had an Anxiety Disorder before; if so whether or not you received treatment and how successful that treatment was; whether or not alcohol and/or substance abuse are involved; whether or not there are other psychological disorders present; and whether or not you feel suicidal and/or are planning to harm or kill yourself.  

How are Anxiety Disorders treated?

       Effective therapies for Anxiety Disorders are available, and research is uncovering new treatments that can help most people with Anxiety Disorders lead productive, fulfilling lives. The most common treatments are medication, psychotherapy, and a combination of the two. Medication can’t cure an Anxiety Disorder, but it can keep it under control while you participate in psychotherapy. The most common medications used to treat Anxiety Disorders are antidepressants, anti-anxiety drugs, and beta-blockers. Antidepressant medications were developed to treat depression but are also effective for anxiety. Although these medications begin to alter brain chemistry after the very first dose, their full effects require a series of changes to occur in the brain, so it usually take about four to six weeks for symptoms to begin to fade. It’s therefore important to take an antidepressant long enough for it to work for you.

      
Antidepressant medications, or antidepressants, were developed to treat depression but are also effective for anxiety. Although antidepressants begin to alter brain chemistry after the very first dose, their full effects require a series of changes to occur in the brain, so it usually take about four to sixs weeks for symptoms to begin to fade. It’s therefore important to take an antidepressant long enough for it to work for you. Antidepressants normalize the functioning of neurotransmitters (chemical messengers) in the brain, primarily serotonin, norepinephrine, and dopamine. These particular chemical messengers are involved in regulating mood, although there's still no complete understanding of how this occurs. Antidepressants include newer types, such selective serotonin reuptake inhibitors (SSRIs) and serotonin and norepinephrine reuptake inhibitors (SNRIs), and older types, such as tricyclics/tetracyclics (TCAs) and monoamine oxidase inhibitors (MAOIs).
 
       SSRIs are used to treat Panic Disorder, Obsessive Compulsive Disorder (OCD), Posttraumatic Stress Disorder (PTSD), and Social Phobia, and combinations of these disorders. The SSRIs include:
  • Celexa (citalopram);
  • Lexapro (escitalopram);
  • Luvox (fluvoxamine);
  • Paxil (paroxetine);
  • Prozac (fluoxetine);
  • and Zoloft (sertraline).
       SNRIs are used to treat Generalized Anxiety Disorder (GAD), Obsessive Compulsive Disorder (OCD), Panic Disorder,Agoraphobia, and Social Phobia, alone or in combination with other disorders. These antidepressants affect the chemical messengers seratonin and norepinephrine, a different set of neurotransmitters than the SSRIs. The SNRIs include:
  • Cymbalta (duloxetine);
  • and Effexor (venlafaxine).
       TCAs, although older than SSRIs or SNRIs, work just as well for Anxiety Disorders, excluding Obsessive Compulsive Disorder (OCD). Tofranil is used to treat Panic Disorder and Generalized Anxiety Disorder (GAD); Sinequan/Adapin are also used to treat GAD; Anafranil is the only TCA useful for treating OCD. The TCAs include:
  • Anafranil (clomipramine);
  • Asendin (amoxapine);
  • Elavil (amitriptyline);
  • Loxitane (loxapine);
  • Ludiomil (maprotiline);
  • Norpramin (desipramine);
  • Sinequan/Adapin (doxepin);
  • Surmontil (trimipramine);
  • Pamelor/Aventyl (nortriptyline);
  • Tofranil (imipramine);
  • and Vivactil (protriptyline).
       MAOIs are the oldest type of antidepressant medication. MAOIs are used to treat a variety of Anxiety Disorders, including Posttraumatic Stress Disorder (PTSD), Panic Disorder and Social Phobia. The MAOIs include:
  • Eldepryl (selegiline);
  • Marplan (isocarboxazid);
  • Nardil (phenelzine);
  • and Parnate (tranylcypromine).
       People who take MAOIs have to eliminate foods containing tyramine from their diets because tyramine can interact with MAOIs to cause dangerously elevated blood pressure. They also have to avoid taking certain medications because these, too, can cause dangerously elevated blood pressure. MAOIs and SSRIs should not be taken together because they can interact to cause a serious condition called “serotonin syndrome” characterized by:
  • confusion;
  • hallucinations;
  • increased sweating;
  • muscle stiffness;
  • seizures;
  • changes in blood pressure or heart rhythm;
  • and other potentially life-threatening conditions.
       Finally, Wellbutrin (bupropion) is a unique antidepressant, unrelated to any other, which, while it's more effective for depression than anxiety, is sometimes used to treat anxiety by itself or in conjunction with an SSRI.
 
       Anti-anxiety medications, primarily benzodiazepines, reduce daytime anxiety and excessive excitement and generally quiet or calm people. At low doses they have few side effects other than drowsiness and dizziness; at higher doses they produce significant drowsiness and facilitate sleep. (WARNING; It is especially important to limit or better yet avoid alcohol while taking any benzodiazepine.) Because they are potentially addictive, benzodiazepines are typically prescribed for only short periods of time, especially for people with histories of alcohol and/or drug abuse. An exception to this is people with Panic Disorder, who can generally take benzodiazepines for up to a year without risk of harm. Benzodiazepines include:
  • Ativan (lorazepam);
  • Centrax (prazepam);
  • Dalmane (flurazepam);
  • Doral (quazepam);
  • Halcion (triazolam);
  • Klonopin (clonazepam);
  • Librium (chlordiazepoxide);
  • Paxipam (halazepam);
  • ProSom (estazolam);
  • Restoril (temazepam);
  • Serax (oxazepam);
  • Tranxene (clorazepate);
  • Valium (diazepam);
  • Versed (midazolam).
  • and Xanax (alprazolam).
       Some people experience withdrawal or discontinuation symptoms if they stop taking benzodiazepines abruptly instead of tapering off of them gradually. Some also experience rebound anxiety, a resurgence of anxiety stronger than they felt before starting on the medication. Unfortunately, these problems inhibit some Primary Care Providers from prescribing benzodiazepines in adequate doses or, in some cases, prescribing them at all.

       Buspar (buspirone), which is not a benzodiazepine, is a unique anti-anxiety medication primarily used to treat Generalized Anxiety Disorder (GAD). Unlike benzodiazepines, Buspar must be taken consistently for at least two weeks before it begins to provide significant benefit.

       Beta blockers such as Inderal (propranolol) are used to treat heart conditions, but can also be used to prevent the physical symptoms of some of the Anxiety Disorders, particularly Social Phobia. Inderal can be used preventitively to treat stage fright, which is classifiable as a Specific Phobia, Situational Type.
 
       If one medication doesn't work, be open to trying another. People who don't improve after taking one medication increase their chances of getting better by switching to a different medication or adding a second medication.

       Psychotherapy involves talking with a trained mental health professional, such as a Counselor, Psychiatrist, Psychologist, or Social Worker, to explore what is causing the Anxiety Disorder and how to manage or eliminate the symptoms. Some types of psychotherapy are short-term (10 to 20 weeks) and others are long-term (more than 20 weeks). Which might be suitable for you can be determined between you and the mental health professional whom you see. There are many types of psychotherapy, all of which can be effective in treating Anxiety Disorders, but two types, Cognitive-Behavioral Therapy (CBT) and Interpersonal Therapy (IPT), have well-established histories of being effective.

       CBT helps people change negative and self-critical styles of thinking and behaving that contribute to or worsen anxiety, replacing them with more positive, functional, and adaptive ways. For example, CBT can help people experiencing Panic Disorder learn that their Panic Attacks are not really heart attacks and help people experiencing Social Phobia learn how to overcome the false belief that other people are always observing and judging them. There are several parts to CBT. These include:
  • Exposure Therapy. This helps people face and control their fears by exposing them to the situation or experience they fear, but in a safe way. It is particularly helpful in treating Specific Phobias.
  • Cognitive Restructuring. This helps people neutralize the negative self-talk and irrational belief systems that often underlie Anxiety Disorders.
  • Stress Inoculation Training. This reduces symptoms by teaching the person how to reduce anxiety through looking at his fears in a more adaptive and functionalway.
       CBT often lasts about 12 weeks. It can be conducted individually or in a group of people with similar problems. Group therapy is particularly effective in treating Social Phobia. CBT often entails “homework,” or exercises, for the client to do in between sessions. Research indicates that the effects of CBT last longer than those of treatment with medication for people with Panic Disorder, and possibly for those with OCD, PTSD, and Social Phobia. If CBT is effective, a recurrence of the disorder can often be effectively treatedquickly and easily with a brief refresher.

       IPT helps people understand and work through dysfunctional and/or maladaptive relationships that contribute to or worsen anxiety. It emphasizes the relationships between a person and other people rather than that person’s internal psychological processes. It’s intended to change the person’s symptoms by helping him deal more realistically and effectively with his family, marital, parental, and work situations.

       For those who are mildly or moderately anxious, psychotherapy alone is often the best treatment option. However, for certain people, especially those who are severely anxious, a combination of psychotherapy and medication may be necessary.

How can I help someone who is suffering from an Anxiety Disorder?

       If you know someone who has an Anxiety Disorder, odds are that his or her anxiety affects you, too. The first and most important thing that you can do to help a friend, family member, or coworker who has an Anxiety Disorder is to help him get diagnosed and treated. You might have to schedule an appointment on behalf of the person or even go with him to see a provider. Encourage him to stay in treatment or to seek different treatment if no improvement occurs after six to eight weeks of medication or eight to 12 weeks of psychotherapy. In addition:
  • don’t downplay or trivialize the anxiety;
  • don’t demand improvement if the person isn't in treatment;
  • offer emotional support, understanding, and patience;
  • engage the person in conversation and, most importantly, listen nonjudgmentally;
  • never criticize or belittle feelings the person expresses, but rather point out realities and offer hope;
  • never ignore comments about suicide. Encourage the person to share these thoughts with his provider and/or mental health professional, and report them yourself if you believe the person won't;
  • invite the person to participate in walks, outings, and other activities. Keep trying even if he declines, but don't push him to do too much too soon. Making the person feel as if you have too many expectations of him may inadvertently cause feelings of failure;
  • and remind the person that, with time and treatment, the anxiety will inevitably improve.
© 2010
Dr. Thomas E. Hranilovich
Licensed Psychologist

Psychiatric Associates / 4084 Okemos Rd. / Suite A / Okemos, MI 48864
Phone: (517) 347-4848 / Fax: (517) 347-4844