happens to everyone. Sometimes it is helpful, such
as in avoiding a car crash or motivating us to study
for a test. But anxiety can become a problem if
it keeps on happening when we are not in danger.
Psychologists classify anxiety problems into “disorders”.
These diagnoses help the doctor know what is mostly
likely to help the anxiety sufferer. Among common
anxiety disorders are:
Compulsive Disorder: Also known as OCD,
it is a very common type of anxiety problem, afflicting
up to 2.5% of the population, (and even up to 10%
if you include other related problems, like some
eating disorders, compulsive gambling, somatization
disorder, and body dysmorphic disorder.) I list
it first because while I treat people with all types
of anxiety, OCD is my true specialty. If you have
OCD you suffer from either:
- unwanted distressing thoughts, ideas, images,
or impulses, that once they are in your head, are
hard to get out of your head, and make you feel
very anxious or distressed.
- behavior or acts, including mental acts and avoidance
behaviors, that you feel driven to perform to decrease
your anxiety and distress.
you have OCD, most likely you suffer from both obsessions
and compulsions, which work hand in hand to create
is very, very treatable using behavior therapy.
Simply put, behavior therapy for OCD is “Identify
the compulsions, and eliminate them”. While
this may sound simple, sometimes it is very difficult,
because in not doing the compulsions people can
get very, very anxious. Therefore I teach people
tools for reducing the compulsions slowly, and techniques
to better manage the anxiety. Finally, once you
have gotten the compulsions under control as they
naturally occur in your life, it is good to do some
exposure therapy to those things that cause the
obsessions and anxiety, and to intentionally not
do the compulsions. This exposure and response prevention
helps prevent relapses in the future.
(with or without agoraphobia):
Panic disorder is characterized by suffering from
panic attacks, periods of extreme anxiety, which
seem to come at first entirely out of the blue.
Symptoms of a panic attack include:
Hot flushes or chills
Trembling or shaking
Numbness or tingling sensations, especially in the
hands, feet, or around the mouth
Feeling of throat closing or gagging
• Tightness, pain, or discomfort
in the chest
• Shortness of breath
Rapid or pounding heartbeat
Nausea or abdominal distress
Feeling like you’re having a heart attack
and are about to die
• Feeling like you are going
crazy or losing control
Feeling like you are watching everything from far
Feeling that things seem too vivid, or not vivid
panic attacks do not come from panic disorder. In
fact, most of the anxiety disorders can generate
panic level anxiety.
some cases people with panic disorder develop agoraphobia,
or severe avoidance behaviors, which might lead
them to become prisoners in their own homes, for
fear that venturing out will trigger a panic attack.
disorder is very treatable with cognitive behavioral
therapy. First I teach people powerful tools to
better manage and reduce their anxiety. As they
use these tools in their everyday lives, anxiety
becomes less intense and less frequent. I also teach
people cognitive therapy techniques to learn to
see the world as a less dangerous place. Finally,
in cases where significant avoidance behaviors have
developed, I teach people how to do “in vivo”,
or real life, exposure therapy to actively confront
their fears by intentionally doing the things they
have been avoiding doing.
are irrational fears of specific situations, such
as flying in an airplane, going on an elevator,
and being in a high place. People can develop phobias
about almost anything, including animals, colors,
being alone, and the dark. Most of us have our own
quirky fears, but when the fear begins to interfere
with living our lives, it is time to do something
about it. When people with a phobia are confronted
with their feared situation, their anxiety can be
quite intense, to the point of panic.
are best treated with behavioral and cognitive therapy
techniques. Anxiety management training helps the
person better tolerate anxiety when trying to approach
the feared situation, and intentional practice doing
the feared activity will almost assuredly decrease
the anxiety. For some phobias it is hard to do “in
vivo”, or real life, exposure, such as riding
on an airplane. In these cases people can learn
how to do exposure in imagery first, as a stepping-stone
to real life exposure.
Also called social phobia, is a fear of social situations.
Sometimes it is limited to very specific social
situations, such as public speaking, test taking,
dating, eating in restaurants, using public restrooms.
Sometimes it is very generalized to virtually any
public situation, such as being in a crowd, being
around strangers, even answering the telephone.
The basic fear underlying social anxieties is a
fear of how others are going to judge or evaluate
of whether the social anxiety is specific or generalized,
cognitive therapy is extremely important in learning
to see the world differently. Anxiety reduction
tools can help decrease anxiety to more manageable
levels, allowing the socially anxious to gradually
expose themselves to more and more anxiety provoking
situations. With practice, the person desensitizes
to the anxiety, and can live a freer life.
Generalized Anxiety Disorder:
Also know as GAD, it is extreme worry, almost all
day, everyday, about different things from minute
to minute. People with GAD are often referred to
as “worry-warts”. The constant worry
usually results in extreme muscle tension, often
resulting in painfully tight muscles in the shoulders
and back, as well as tension headaches.
responds very well to a combination of cognitive
and behavioral treatments. Cognitive therapy techniques
teach the person to better evaluate the real versus
the imagined risks in life, and behavioral approaches
teach the person to delay and eventually the excessive
worry, and to alleviate the muscle tension that
further feeds GAD.
This form of anxiety is usually limited to children
or early adolescents. Some separation anxiety is
the norm for most of us at some point in our lives.
But in some cases it becomes extreme, leading to
difficulties going to school, or being away from
a parent or a caregiver for even a moment.
with many childhood anxiety problems, it is often
best addressed by developing a behavior modification
program administered by the adult. In such a case
children can be rewarded for specific behaviors,
such as going to school on the bus, or staying in
their own bed at night. These rewards are often
done with stars on a star chart (a calendar where
the child gets to affix a colorful star each night
he/she stays in bed all night). These stars are
then used for rewards, usually doing something special
with Mom or Dad. Also, even very young children
can learn to overcome their irrational fears by
learning that: “The more afraid you act, the
more afraid you get. And the less afraid you act,
the less afraid you get.”
Stress Reaction: Imagine witnessing a horrendous
accident. All of us would become anxious to some
degree. Some of us would find this anxiety lingering
and beginning to invade our lives. This would be
an acute stress reaction.
management training, learning to use cognitive and
behavioral tools to decrease anxiety, is an excellent
way to quickly put the intense anxiety reaction
behind you. Prompt treatment of an acute anxiety
reaction may lessen the possibility of later developing
Post Traumatic Stress Disorder:
Commonly referred to as PTSD, it is the long-term
anxiety reaction to having experienced traumatic,
anxiety provoking situations. It is most commonly
thought of as being a result of combat experiences,
but can result from other traumas such as accidents
and crimes. It can result in the same intense panic-level
anxiety as the other anxiety problems, and can also
result in flashbacks, where the person finds himself
or herself reliving the traumatic event, or recurring
nightmares about the traumatic event.
cognitive and behavioral therapies are helpful with
PTSD. Anxiety reduction tools can help one stem
the rise of anxiety from ever getting to panic proportions.
Exposure to triggers that activate the traumatic
memories can result in desensitization to the anxiety,
so that being in those situations no longer results
in high anxiety.