By Julie Stroemel, PsyD, Everett Christian Counseling, PLLC
What is the difference between a little worry and an anxiety disorder?
Most of us experience anxiety at some point in time. Not all anxiety is bad. A little extra focus and concern often helps us to complete projects and assignments on time. In other circumstances, anxiety can help us to take action quickly if the situation is threatening.
Anxiety is a response to perceived danger or threat. It is a natural state that can, in moderate degree and frequency, be a useful tool to maintain someone’s safety. However, when a person experiences ongoing extreme fear and worry that does not go away, he or she may be suffering from an anxiety disorder. At times, the person may experience anxiety so intensely and frequently that it becomes difficult to complete normal day to day activities, or to work. Fortunately, anxiety disorders can be effectively treated and their symptoms can be reduced with the help of a qualified mental health professional.
Determining the Cause of Anxiety
Before any treatment, it may be helpful to have a check-up by a medical doctor to determine whether a person’s symptoms come from an anxiety disorder or from a physical problem, such as a thyroid condition, or other health problem, depression, or substance abuse. Sometimes, treatment for the anxiety disorder must wait until the person has received treatment for these other conditions. Once health issues have been ruled out as a cause, it is helpful to work with a Christian counselor to learn techniques for managing the symptoms of anxiety.
Types of Anxiety Disorders
There are a number of different types of anxiety disorders, which I outline below.
Generalized Anxiety Disorder
This is characterized by recurring fears or worries about the same thing, such as health or finances. A person who has generalized anxiety disorder may feel as if something bad is just about to happen. The intensity of the fears or worries may impair the person’s ability to focus and to concentrate on daily responsibilities.
This involves sudden, intense and unprovoked feelings of fear, terror, and dread. People with this disorder may develop intense fear and worry about when and where their next panic attack may happen, and, as a result, will often become withdrawn from activities they used to engage in. During these attacks, a person may experience symptoms such as shortness of breath, palpitations, chest pain or discomfort, choking or smothering sensations, and fear of “going crazy” or losing control.
This involves intense fears associated with certain objects or situations. Specific phobias may involve fear of flying in an airplane, or encountering a type of insect or animal, or being afraid of heights or closed spaces such as elevators. These phobias are often triggered by an initial isolated negative experience, but may become over-generalized to broader categories or circumstances.
People with this condition experience fear related to places or situations where they expect to experience a panic attack or panic-like symptoms, particularly if they believe that escape may be difficult or impossible. Common situations include being in a crowd of people, traveling in a car, bus, or airplane, being in an elevator, on a bridge, or being alone outside the home or being home alone.
This involves intense fears of being in social settings and public places, and may involve fear of public speaking.
People who struggle with this often experience persistent, uncontrollable and unwanted feelings or thoughts (obsessions) and engage in routines or rituals (compulsions) through which they seek to prevent or stop the unwanted thoughts. Some common compulsions include cleaning excessively for fear of contamination from germs, checking and re-checking locks, repeatedly checking for errors, or excessive hand-washing.
Post-Traumatic Stress Disorder
This may occur when someone suffers severe physical or emotional trauma as a result of a life-threatening situation, such as a natural disaster, serious accident, or as a victim of a crime. The individual may become seriously impacted by reminders of the event that bring up thoughts, feelings, and experiences related to the traumatic experience. Sometimes this may impact a person for months to years after the traumatic experience.
Symptoms of an Anxiety Disorder
Those who experience an anxiety disorder may feel extreme fear, shortness of breath, a racing pulse, nausea, trembling, or dizziness, or they may have difficulty sleeping. Anxiety disorders may occur throughout a person’s lifespan, but often begin in adolescence or early adulthood. There is evidence suggesting that anxiety disorders run in families due to genetics as well as early learned experiences.
Treatment for Anxiety Disorders
If anxiety disorders are left untreated, serious consequences can result. For example, some people may begin to avoid any situation that triggers anxiety or panic, which can affect their ability to go to work, take care of their family, or complete the basic activities of daily living. People who suffer from untreated anxiety disorders may also develop depression and feel hopeless, which increases the risk of substance abuse. Relationships with their family, friends and coworkers may also suffer, and their work productivity may decline.
The good news is that anxiety disorders are treatable. An experienced Christian counselor can assist with cognitive techniques (ways of thinking) that can improve the symptoms, as well as behavioral techniques (actions and habits) that can move the person toward a healthy lifestyle. At times, a combination of Cognitive-Behavioral Therapy and other styles of therapy, as well as coordination with your doctor for medication management, can result in the fastest and most lasting improvement in your symptoms.
Medication in the Treatment of Anxiety Disorders
Doctors may prescribe medication, along with talk therapy, to help relieve anxiety disorders. Some medicines may take a few weeks to work. Your family doctor or psychiatrist may prescribe:
These medications take up to four to six weeks to begin relieving anxiety. The most widely prescribed antidepressants for anxiety are the SSRIs (selective serotonin reuptake inhibitors). These can be very effective in managing anxiety symptoms, but will need to be closely monitored by your doctor. Commonly prescribed antidepressants are Prozac, Zoloft, Paxil, Lexapro, and Celexa.
Also called “tranquilizers,” these medications produce feelings of calm and relaxation. Side effects may include feeling sleepy, foggy, and uncoordinated, and some people may experience short-term memory impairment. The higher the dose, the greater the chance of side effects. Benzodiazepines are the most common class of anti-anxiety drugs, but are habit-forming and are therefore prescribed with caution. Commonly prescribed anti-anxiety drugs are Xanax, Klonopin, Valium, and Ativan.
These medications block norepinephrine, the body’s “fight-or-flight” stress hormone. This helps control the physical symptoms of anxiety and panic, such as rapid heart rate, a trembling voice, sweating, dizziness, and shaky hands. Because beta blockers don’t affect the emotional symptoms of anxiety, such as worry, they’re most helpful for phobias, particularly social phobia and performance anxiety. Commonly prescribed beta blockers include Tenormin and Inderal.
This medication is often used to treat blood pressure, but has also been found to be effective in treating traumatic nightmares and certain symptoms related to PTSD. It is a centrally active alpha-1 adrenergic antagonist that counteracts the noradrenergic activity in the brain seen with PTSD.
At times your counselor may team up with your doctor for a combined treatment of therapy and medication. Skills learned in counseling may help a person to manage symptoms that are genetically passed on, as well as learned patterns of responding that contribute to your symptoms. The Anxiety Disorder Research Center at UCLA has identified genetic variations that are present in people with anxiety disorders, and have found that different forms of anxiety disorders may run in families. That said, God knows exactly how he made you, and his desire for you is to live free from fear.
Oh Lord, you know me. You know when I sit and when I rise; you perceive my thoughts…You discern my going out and my lying down, you are familiar with all my ways. (Psalm 139:1-3, 5, NIV)
Christian Counseling Can Assist with Anxiety Disorders
If you are struggling with an anxiety disorder, you do not need to do this alone. A Christian counselor can help you to gain a healthy perspective on life and to develop the skills that enable you to face your problems. If you would like to know more about how Christian counseling can help with anxiety disorders, please reach out and contact me here.
The American Psychological Association (APA), 2014.
The American Journal of Psychiatry, February 2003
The Anxiety Disorder Research Center at UCLA, 2014 (http://anxiety.psych.ucla.edu/anxdis.php)
The National Institutes of Health (NIH), 2014
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