BMN Blog

MAR 13
It’s Not Just Stress: Removing the Cloak of Anxiety

In a world of rapidly accelerating technology, our lives have become a 24hr sprint of endless tasks to be completed within a certain timeframe. Doctor offices are inundated with patients many young in age presenting symptoms such as high blood pressure, racing heartbeat, headaches, chest pain, random sweats, insomnia, and gastrointestinal problems. With the increased volume of patients and the demanding time constraints experienced in physician offices, these physical symptoms are often treated individually. The physician may prescribe medication, make recommendations on possible lifestyle changes, yet the symptoms remain. Effective treatment has to go deeper. These patients could be simply suffering from stress or they could be dealing with a more problematic subset of mood disorders: Anxiety Disorders.

 

Stress and Anxiety Disorders can exhibit similar symptoms. A distinction between the two is that while stress tends to be managed through lifestyle changes, anxiety disorders require both lifestyle changes and professional treatment options (therapeutic interventions and psychotropic medications).

 

Two ways to distinguish between anxiety disorders and stress:

  • Stress oftentimes is the result of externally specific pressures which can last for weeks.
  • Symptoms of Anxiety Disorders can occur in acute episodes that last for at least 6 months. In addition even after the problem has been resolved, symptoms continue for at least another 6 months.

 

Stress is the body’s reaction to any change that requires adjustment.   The body reacts to these changes with physical, mental, and emotional responses. Stress effects all aspects of one’s life. As a result, individuals can experience stress differently.  

 

Emotional symptoms of stress may include:

  • Becoming easily agitated
  • Feeling overwhelmed
  • Having difficulty relaxing
  • Feeling bad about yourself (low self-esteem), worthlessness
  • Socially withdrawal

 

Physical Symptoms of stress may include:

  • Low energy
  • Headaches
  • Gastrointestinal troubles
  • Tense muscles
  • Chest pain, rapid heartbeat
  • Insomnia
  • Nervousness, shaking, ringing in the ear
  • Cold or sweaty hands and feet

 

The physical symptoms above also apply to Anxiety Disorders. However, Anxiety Disorders are typically diagnosed when fear of non-threatening situations, places, events or object becomes extreme, uncontrollable and persistent.  Anxiety is also commonly diagnosed if general feelings of fear or worry interfere with daily life. Just like Depressive Disorders, Anxiety Disorders are a constellation of multiple diagnosis making it all the more important to sift through patients self-reported symptoms accurately. Common Anxiety Disorders that will be addressed in this article are Generalized Anxiety Disorder, Panic Disorder and Social Anxiety Disorder.

 

Generalized Anxiety Disorder (GAD) can be thought of as persistent, excessive and uncontrollable worry about a number of different things including work, school performance and finances, etc.  Individuals who experience GAD also report a number of physical symptoms such as restlessness, feeling on edge, muscle tension, sleep disturbance and fatigue.

 

According to the DSM-V the following criteria are required to meet the diagnosis of Generalized Anxiety Disorder:

  • Excessive anxiety and worry, occurring more days than not for at least 6 months, about a number of events or activities.
  • The individual finds it difficult to control the worry.
  • The anxiety or worry are associated with three or more of the following symptoms:
    • Restlessness or feeling keyed up or on edge
    • Being easily fatigued
    • Difficulty concentrating or mind going blank
    • Irritability
    • Muscle tension
    • Sleep disturbance
  • The anxiety, worry or physical symptoms cause clinically significant distress or impairment.
  • The disturbances are not attributable to the physiological effects of a substance.
  • The disturbance is not better explained by another mental disorder.

 

Panic Disorder is identified when the individual experiences recurrent unexpected panic attacks and is persistently worried about having more panic attacks. Individuals in this situation also tend to change their behavior in maladaptive ways (irrational) because of the panic attacks (e.g. avoidance of certain activities or situations, etc.).

 

According to the DSM-V the following criteria are required to meet the diagnosis of Panic Disorder.

  • Recurrent unexpected panic attacks. A Panic attack is an abrupt surge of intense fear or intense discomfort that reaches a peak within minutes, and during which time four (or more) of the following symptoms occur:
    • Palpitations, pounding heart or accelerated heart rate
    • Sweating
    • Trembling or shaking
    • Sensations of shortness of breath or smothering
    • Feelings of choking
    • Chest pain or discomfort
    • Nausea or abdominal distress
    • Feeling dizzy, unsteady, lightheaded or faint
    • Chills or heat sensations
    • Paresthesias (numbness or tingling sensations)
    • Derealization (feelings of unreality) or Depersonalization (being detached from oneself)
    • Fear of losing control or “going crazy”
    • Fear of dying
  • At least one of the attacks has been followed by 1 month of one or both of the following:

                     Persistent concern or worry about additional panic attacks or their consequences.

                     A significant maladaptive change in behavior related to the attacks.

  •  The disturbance is not attributed to the physiological effects of a substance
  •  The disturbance is not better explained by another mental disorder. 

In Social Anxiety Disorder (formally known as social phobia) the individual is fearful about social interactions and situations that involve the possibility of being negatively evaluated by others, embarrassed, humiliated or rejected. These social interactions may include meeting unfamiliar people, eating in public where individual may be observed eating or drinking, and performing in front of others.

According to the DSM-V the following criteria are required to meet the diagnosis of Social Anxiety Disorder.

  • Marked fear or anxiety about one or more social situation in which the individual is exposed to scrutiny by others.
  • The individual fears that he or she will act in a way or show anxiety symptoms.
  • The social situations almost always provoke fear or anxiety
  • The social situations are avoided or endured with intense fear or anxiety.
  • The fear or anxiety is out of proportion to the actual threat posed by the social situation.
  • The fear, anxiety, or avoidance is persistent, typically lasting six months or more.
  • The fear, anxiety, or avoidance is not attributable to the physiological effects of a substance.
  • The fear, anxiety, or avoidance is not better explained by another mental disorder. 

 

Treatment

There are a number of treatments available to individuals suffering from an Anxiety Disorder. Treatment is determined by how significant the disorder is affecting one’s ability to function daily. The two main treatments are psychotherapy and/or psychotropic medications. Psychotherapy combined with psychotropic medications has been proven to be the most effective treatment for Anxiety Disorders. Eighty percent of patients treated show an improvement in their symptoms generally within four to six weeks of beginning medication, therapeutic interventions, and/or support groups. 

Therapeutic Intervention (also known as counseling or psychotherapy) will not only improve the quality of life for the patient but also enhance their ability to cope with a future life crisis. Intervention is not about “fixing” the patient. The goal is to help them cope with their symptoms and gain a confident understanding of their current diagnosis. Therapeutic interventions that therapists use in treatment can vary greatly. Cognitive Behavioral Therapy (CBT) is a widely used evidenced-based module used by many counselors and psychologists.  It involves helping patients identify their irrational beliefs about themselves and others (known as automatic thoughts) and develop coping strategies to target and change them. CBT can help individuals maintain a sense of control and self-confidence in learning to control their thinking. Although there may be some truth in these automatic thoughts, an anxious patient can unknowingly exaggerate and even distort the reality of their situation.   With CBT, a patient can learn to recognize and correct these negative thoughts that fuel the symptoms of their disorder. 

To keep up with the todays society and the ever-evolving human psyche, therapeutic interventions also evolve and are tailored to the patient. During intake sessions Therapists listen to the patient’s needs, concerns, and expectations of therapy.  This allows the Therapist to decide which theoretical approach is best and also start developing a rapport and comfortable environment that encourages patients to disclose their personal emotions and experiences.  One of the most important things to remember about therapy is that the dialogue in sessions is confidential in order to give, the patient confidence to speak honestly, and openly without fear of being criticized, judged or hurt.

In developing a patient’s treatment plan, going deeper is paramount. Symptoms of Anxiety Disorders can remain hidden, either because a question was not asked by the healthcare professional or the patient was fearful of fully revealing what was causing them distress. Anxiety Disorders are primarily defined by fear.  It is imperative that we identify this fear to provide patients the proper treatment. The world will never slow down. That is why it is important for healthcare professionals to provide patients with the tools they need to maintain their balance throughout the chaos in a rapidly accelerating world.

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