Male doctor, female patient.
(photo credit: Thinkstock/Imagebank)
A lovely woman I had been treating told me one day that she loved to travel to different countries, but confided that she was a real white-knuckle traveler. She said that in flight she’d practically make marks in her husband’s skin from grabbing so tightly, but once at her destination she was fine and able to enjoy herself. On a subsequent office visit she had just returned from Europe and when I asked how her trip was, she replied “wonderful,” clearly bubbling with enthusiasm. She said, “You know, I was sitting in the back of the plane and I suddenly thought, ‘why am I worrying? I don't need to worry. No matter what I do and how much I worry, it won’t make the pilot fly any better. It is time I worry about the things I can do something about and leave the flying to him. That is his job.’” She said that after this realization she was fine. Once she acknowledged that there were things that she couldn’t control, she sat back and let the experts do their job.
Ah, if all worries were that easy to resolve.
ARE YOU a worrier? Do you find that things that don’t bother others keep you up all night? Do you dread public speaking, worry that you have an undiagnosed or fatal disease or feel awful at the thought of taking an elevator or an airplane? Do you find yourself avoiding more and more places and situations? Do things that barely bothered you before now make you feel quite anxious? Do you have horrible panic attacks that come on suddenly from nowhere and have you feeling like you could die? Does your child not want to go to school or cry when you go out at night? If you answered “yes” to any of the above questions, you or your child may be suffering from an anxiety disorder.
Just about everyone worries or is anxious at some time in their life. However, when worry is persistent and excessive, when fear takes over or when you feel repeated and uncontrollable panic, it is time to take action. Anxiety disorders include everything from mild phobias to fullblown panic attacks and are both very common and quite unsettling. They may exist on their own or be accompanied by depression or other medical conditions.
In fact, some medical conditions mimic symptoms of anxiety and thus it is always important for the psychologist to take a comprehensive history before beginning therapy.
It is not unusual to experience irritability, have difficulty concentrating, have muscle tension, difficulty sleeping or eating and have issues about leaving the house. Symptoms can vary from mild distress to difficultly breathing, palpitations, sweating, shaking, feeling faint, numbness, tingling of the extremities, abdominal discomfort and chest pain that feels similar to a heart attack.
I’ve seen children of all ages, as well as adults, present in my office with a host of symptoms in one way or another connected with anxiety, and while many may acknowledge that their fears seem irrational, that is of little comfort to them. One thing that fears, phobias, anxieties and worries all have in common is that for the patient they are most unpleasant and can result in difficulties attending school or work, impede social functioning and have a tremendous impact on the entire family and other loved ones. If untreated, a person can suffer for years and may even worsen. Treated, with time, a person generally does very well.
The etiology of anxiety disorders is uncertain but it is thought to be a combination of genetic predisposition, biological and psychological factors. Brain biochemistry along with the impact of previous life experiences and individual personality differences are all thought to play some role, and their contribution will no doubt become clearer with time.
Treatment is designed to help the individual better cope by gaining control over anxiety and reducing worry. Cognitive behavioral therapy, or CBT, is the most effective psychological treatment for anxiety and consists of changing one’s thought patterns and reactions to the fearful situation by examining one’s thoughts, feelings and reactions in connection to the anxiety- producing event or situation.
Most people suffering from anxiety tend to imagine the worst-case scenario and assume that it will happen to them. Your plane will crash, everyone will laugh at you if you talk in class, or Mom will get hurt if she leaves the house. The likelihood of these happening is extremely small but this faulty logic prevails over more rational thinking. The average person is more worried about a possible terrorist attack, which has lower fatality numbers than car accidents, because terror invokes irrational fear. Effective treatment examines these automatic irrational thoughts, eliminates catastrophic thinking (which uses words such as “always” and “never”) and encourages more accurate and optimistic thinking.
Systematic desensitization or gradual repeated exposure (through role-playing, imagery or real life) to the feared events, coupled with relaxation strategies to reduce stress and anxiety, are also very important components of therapy and help remove the connection of fear to the event. Practical skills such as problem solving, social skills, time management and goal-setting can also help alleviate stress. When warranted, psychopharmacological medication may be used independently or in conjunction with CBT. Anti-anxiety medications, typically benzodiazepines, offer a fast-acting solution for acute anxiety. They have addictive potential, though, if used longterm.
Antidepressants, prescribed at the lowest possible dose, often offer a more suitable long-term solution but take longer to work.
While anxiety may feel crippling, with help, you can overcome your fears and move on to enjoying life again. Isn’t that worth investing?
The writer is a licensed clinical psychologist in private practice in Ra’anana. Send correspondence to [email protected] or visit her website at www.drbatyaludman.com. Her book, Life’s Journey: Exploring Relationships – Resolving Conflicts, has recently been published by Devora Publishers.