Anxiety

Phobias are constant, excessive fears of an object or situation that interfere with one's life and/or cause personal distress. Phobias are among the most common types of psychiatric disorders, with 11% of the population subject to a phobia at some point in their lives, and 5.5% of the population subject to a phobia within a given 30-day period. Many people learn to manage their phobia with minimal difficulties.

For example, a person with a spider phobia might avoid activities such as camping, but otherwise does not notice a disruption in his or her life. However, for phobias that cause noticeable life interference, there are effective treatments that are successful in up to 90% of cases.

What causes phobias?

There are many ways a person can develop a phobia. Some individuals remember a particularly traumatic experience with the feared object or situation. More often than not, however, people report that they have had the phobia as long as they can remember, or that they were always fearful of an object or situation and that it gradually developed into a phobia. Most psychologists believe that a combination of factors explains why phobias develop, including biological vulnerability, such as the tendency to be startled or alarmed, traumatic experiences with feared objects or situations, observations of others reacting fearfully to certain objects or situations, and learning information about the danger of certain objects and situations. These circumstances, in turn, make it likely that phobic individuals will develop problematic ideas about the feared object or situation, such as the amount of danger it poses, the frequency with which they will encounter it, and their ability to cope with it. Interestingly, people are more likely to develop phobias of insects and storms rather than guns or knives. Many researchers believe things like insects and storms posed a threat to our ancestors, and it helped them to survive if they had a moderate level of fear toward them.

How do phobias affect relationships and family life?

At times, phobias can cause disagreements in close relationships, as they can limit the activities that partners and families can do together. Families of children with phobias often create time-consuming rituals to structure the phobic child's environment so that the child either successfully learns to deal with the phobia, or so that the family can avoid a "scene" caused by the phobia. Partners and family members often find themselves trying to strike an unstable balance between showing love and concern toward the phobic individuals, and encouraging them to overcome their fears.

Post-Traumatic Stress Disorder (PTSD) is a psychiatric diagnosis for people who have endured a highly stressful and frightening experience and who are experiencing distress caused by memories of that experience. It is as if a person is "possessed" by memories of an experience and just cannot let go. Because anxiety is the major sign of PTSD, it is classified as an anxiety disorder. Other anxiety disorders are phobias, panic disorders, and generalized anxiety.

The good news is that it is highly treatable when diagnosed early. The bad news is that it is often missed by examining physicians and mental health professionals, or it is misdiagnosed as some other condition that is more neurobiochemical in nature. But there is no drug cure for PTSD.

Is it possible that there can be a delayed reaction to the traumatic event?

Yes. There are three types of PTSD:

• Acute: when the above symptoms last between one and 3 months after the trauma
• Chronic: when the symptoms last for at least 3 months following the trauma.
• Delayed: when symptoms do not show up for at least 6 months after the trauma. This is often found with adult survivors of childhood traumas.

What are other effects of trauma?

When PTSD is detected, other symptoms and characteristics are found too. This is why PTSD is so often misdiagnosed. Among the major sets of symptoms are phobia and general anxiety (especially among former POWs and hostages and natural disaster survivors), substance abuse, depression, psychosomatic complaints, an altered sense of time (especially among children), grief reactions and obsessions with death (especially among those who survived a trauma in which someone could have died), feeling guilty, and increased interpersonal conflicts. For some who have PTSD, these other features go away once the PTSD symptoms are eliminated through treatment.

What kind of help is there for PTSD?

Both drugs and psychotherapy can be helpful. The most effective treatment approaches are called "cognitive-behavioral" because they focus both on the way traumatized persons view the trauma and on their resulting behavior. Exposure therapy includes systematic desensitization (training to relax in the face of frightening reminders of the trauma) and imaginable, in-vivo techniques such as flooding or the process of putting the client back into the trauma psychologically. The most effective treatment for PTSD includes a variety of anxiety management training strategies. Some of these include Rational Emotive Therapy, various kinds of relaxation training, stress inoculation training, cognitive restructuring, breathing retraining, biofeedback, social skills training, and distraction techniques. Innovative therapists are successful in combining various techniques to fit the trauma and the patient’s unique requirements.

Families are the best setting to help those who suffer from this stress disorder. Families know when a member is acting differently than before the traumatic event. A therapist may work with you or your family member with PTSD to remember the trauma and reprocess the information and mourn losses. This also means that you will learn self-soothing techniques and ways to limit the distress during and between sessions. Your therapist will help you disconnect from the trauma so that reminders do not arouse distress. In doing so, the therapist will help you reconnect to life now and in the future without being haunted by the trauma. Sometimes this transition to life without the trauma is harder than expected.

The reconnecting is especially important: once you are desensitized from the burdens caused by the traumatic event, family therapy enables you to turn your attention to the future. You will attempt to learn from the traumatic events and make needed changes in your personal life and relationships, especially love relationships.

So there is hope for me and my family?

Family therapy offers an extraordinary and useful resource for helping families survive a major traumatic event. Social scientists have documented the remarkable and consistent patterns of emotional recovery from a wide variety of traumatizing events. There is a large number of treatment approaches available today. It is impossible to prevent traumatic events but family therapy can help promote recovery more quickly, and enable family members to get back to what they do best: love each other.

Obsessive-compulsive disorder (OCD) is a common anxiety disorder that affects about 1 to 2% of the population. As its name implies, the symptoms of OCD involve obsessions that lead to compulsions. Obsessions are recurrent and persistent ideas, thoughts, images, or impulses that may cause a great deal of anxiety or distress. People experiencing these obsessions typically find them to be disturbing and intrusive, and usually recognize that they don't make a lot of sense. In response to obsessions, people with OCD try to get rid of them by way of compulsions-acts that are done over and over again, and often according to certain personal rules. Also called rituals, compulsions are usually aimed at preventing or reducing distress and anxiety, or preventing some feared event or situation.

Obsessions and compulsions can take many forms. A few examples include: drivers who fear that they've hit a person every time they run over a pothole or bump on the road. In response to such an obsession, these persons may resort to compulsions such as retracing their routes to be sure no harm was done, or avoid the particular road altogether in the future. Individuals who fear or are obsessed with germs may wash their hands repeatedly throughout the day after touching any potentially "germy" objects, such as door handles, money, or newspapers. Often, their hands are sore and raw from repeated washing, but they can't seem to stop washing. Others who might be obsessed with order and cleanliness may compulsively arrange items in a particular order, or clean their home floors many times a day. Those who fear burglary, fires, or floods may repeatedly check door locks, stove burners, and taps to ensure that their homes are safe. Over time, such repetitive actions work less and less effectively, and the persons may experience anxiety and often depression in response to the increasing obsessions and compulsions.

Besides causing a great deal of stress, OCD symptoms may take up a lot of time (more than an hour a day for some diagnosed people) and may significantly interfere with a person's work, social life, or relationships. OCD can be a challenging problem but fortunately, very effective treatments for OCD are now available to help individuals and families lead a more satisfying life.

What treatments are available for OCD?

There are several types of effective treatments for individuals with OCD and their families. The most common types of treatments are the following:

1. Cognitive Behavioral Therapy (CBT)
   • This treatment has two parts: behavioral therapy and cognitive therapy. Behavioral therapy involves exposure and response prevention. Exposure is designed to reduce the negative emotions (anxiety and guilt) brought on by obsessions. It is based on the idea that anxiety usually decreases after lengthy contact with something feared. For example, people with obsessions about germs will be advised to stay in contact with "germy" objects, such as money. In order for exposure to be most helpful, it needs to be combined with response prevention (RP). In RP, the person's rituals (or compulsions) are blocked. For example, those who worry a lot about germs will be advised to stay in contact with "germy" objects, but avoid the compulsion to wash their hands excessively. This repeated exposure without rituals assists individuals to understand that coming into contact with certain objects or situations will not lead to the initial fear-in this case, becoming ill from the germs found on common objects.
   • CBT's second part is cognitive therapy (CT). It is often combined with behavioral therapy to help reduce the catastrophic thinking and exaggerated sense of responsibility often seen in OCD. In cognitive therapy, the therapist asks the client a series of questions to help him/her identify and evaluate the interpretations and beliefs that lead to typical OCD behavior. Once these beliefs are identified, the therapist will use a variety of strategies to assist the client in challenging the faulty assumptions that are seen in OCD.
2. Behavioral Family Treatment
   • Whenever possible, it is helpful for family members to participate in the treatment of OCD. Family members and persons with OCD both tend to benefit when the family members participate in psychoeducational groups. These groups educate family members about OCD and provide strategies that the family can use to assist and support the member with OCD.
3. Medication
   • Research shows that the use of medication, specifically serotonin reuptake inhibitors (SRIs), is beneficial for the treatment of OCD. Most research shows that medication alone does not get rid of OCD, but it reduces the force of obsessions and urges to engage in rituals (for example, excessive hand washing), thereby allowing the person with OCD to have more control over their thoughts and behaviors.

It’s the extreme fear of being scrutinized and judged by others in social or performance situations: Social anxiety disorder can wreak havoc on the lives of those who suffer from it. This disorder is not simply shyness that has been inappropriately medicalized: Read about the difference.

Symptoms may be so extreme that they disrupt daily life. People with this disorder, also called social phobia, may have few or no social or romantic relationships, making them feel powerless, alone, or even ashamed.

• About 15 million American adults have social anxiety disorder
• Typical age of onset: 13 years old
• 36 percent of people with social anxiety disorder report symptoms for 10 or more years before seeking help

When Young People Suffer Social Anxiety Disorder: What Parents Can Do

Case example: Michael was driving home from work one day and was caught in traffic. He suddenly noticed that his heart was beginning to race. He then felt short of breath, and tightness in his chest. When he began to sweat, he became concerned and drove to the nearest emergency room where they could find nothing physically wrong with him. Michael had just experienced his first panic attack. Over the next few weeks, the attacks became worse, and he started to avoid driving altogether.

Panic disorder is a type of anxiety disorder in which the key symptom is the experience of unexpected panic attacks. These panic attacks consist of physical and/or cognitive symptoms such as racing heart, dizziness, blurred vision, fear of death, trembling, sweating, and shortness of breath. As shown in the above example, the experience of panic attacks may lead to the development of avoidance behavior, known as agoraphobia. In Michael's case, he started to avoid driving out of concern that he might have another panic attack, so his agoraphobia was limited to driving. However, it is common for avoidance behavior to occur in multiple situations. Those with panic disorder with agoraphobia may stop or reduce activities such as drinking coffee, sexual encounters, or taking hot showers in an effort to control the sensations that are associated with panic attacks.

 Panic disorder with agoraphobia is the most common of the panic-related disorders, although individuals may also report panic disorder without agoraphobia (panic attacks without avoidance behavior) or agoraphobia without a history of panic (avoidance behavior related to one or two sensations of panic, but has never had an actual attack).

Knowing When to Seek Help

In general, a person should consider seeking help when the anxiety occurs too frequently, intensely, or is becoming disruptive in daily functioning (e.g., going to fewer parties or social gatherings, going out to stores or movies less than usual). A good rule to follow is to be conservative and consider seeking help from a mental health professional when you notice the following:

• Frequently occurring panic attacks. If you have noticed that the attacks are increasing in either frequency or intensity, it may be a sign that they are becoming more difficult to control. At these times, it is advisable to seek help before the attacks begin to greatly interfere in your life.
• The appearance of avoidance behavior. If you notice a decrease in the amount of time you spend in activities you have typically done in the past, you may want to consider seeking help, especially if the reason for the decrease is related to experiencing panic attacks. The same can be said for activities that may bring on some of the sensations of panic (e.g., coffee). If you are changing your behavior to reduce the number of activities that are associated with panic symptoms, you may be letting the fear of the sensations control your behavior at a subtle level, and should consider seeking help from a qualified mental health professional.
• Dependency. If you notice that you are becoming more dependent on others to accomplish tasks that you would normally do because of the possibility of experiencing a panic attack, you may want to seek help. While this behavior is functional in the short-run, in the long-run dependency may intensify your anxious symptoms.
• Use of safety-signals. Safety-signals are objects or people that you feel comfortable with and signal that you are less likely to experience a panic attack. As such, it is common for individuals with panic to seek safe objects or people. If you notice that you want others (e.g., spouse or partner) to accompany you more during usual activities, then you may want to seek help.

Generalized anxiety disorder is characterized by persistent, excessive, and unrealistic worry about everyday things.

People with the disorder, which is also referred to as GAD, experience exaggerated worry and tension, often expecting the worst, even when there is no apparent reason for concern. They anticipate disaster and are overly concerned about money, health, family, work, or other issues. GAD is diagnosed when a person worries excessively about a variety of everyday problems for at least 6 months. Learn more symptoms.

Sometimes just the thought of getting through the day produces anxiety. They don’t know how to stop the worry cycle and feel it is beyond their control, even though they usually realize that their anxiety is more intense than the situation warrants.