Understanding and Treating Anxiety
Anxiety disorders are conditions in which everyday worry and concern become an interference in your daily life, and/or cause you distress. While nervousness and worry are part of every person’s normal experience, it becomes a mental health issue when the anxiety starts to intrude on daily life and become quite upsetting for the person experiencing it. Anxiety can manifest in a variety of ways, which will be discussed in more detail later in this article.
Key takeaways:
- anxiety is common, but treatable
- anxiety manifests in many different ways
- clinicians at Cabot know how to help treat anxiety
For example, different types of anxiety disorders can be general and non-specific (Generalized Anxiety Disorder [GAD]), show up in acute anxiety bursts (Panic Attacks or Panic Disorder), or be specific to certain objects or situations (Specific Phobias, Social Anxiety Disorder, Obsessive-Compulsive Disorder [OCD], etc.). They all have a substantial and negative effect on your mental health.
What are Common Symptoms of Anxiety?
Common symptoms of anxiety disorders include feelings of nervousness, restlessness or tension; worry and concern about any number of things (e.g. the future, social situations, certain objects or animals, etc.); physical symptoms (i.e., muscle tension, rapid heartbeat, sweating, trembling); a sense of impending danger; feeling weak or tired. The Diagnostic and Statistical Manual (DSM-5), which is the go-to guide for mental health professionals, describes different types of anxiety disorders and lists the criteria for each. The manual specifically cites the interference and distress inherent in any type of anxiety disorder. The authors of the DSM-5 (well-respected psychologists and psychiatrists who are outstanding in their fields) also write that, in diagnosed anxiety disorders, “the person finds it difficult to control the worry.” At Cabot, we have found that anxiety disorders often manifest as a combination of multiple diagnoses, and we call that “Unspecified Anxiety Disorder.”
Generalized Anxiety Disorder (GAD)
Generalized Anxiety Disorder (GAD) is an anxiety disorder in which excessive anxiety and worry, about a variety of topics, occur more than half the days within six months, decreasing your sense of mental health and wellbeing. This anxiety is difficult to control, and includes at least half of the following symptoms: Restlessness, being easily fatigued, difficulty concentrating, irritability, muscle tension, and/or sleep disturbance. As mentioned above, this anxiety interferes with daily life, and can be very distressing to the person experiencing it. In my own work, I have heard people describe it as “free-floating” anxiety, indicating that “it can land anywhere.” For that reason, among others, GAD can be an extremely frustrating and disheartening condition, playing Whack-a-Mole with extreme fear and discomfort.
Substance/Medication-Induced Anxiety Disorder
Substance or Medication-Induced Anxiety Disorders are very much what they sound like. Any of the anxiety disorders (or a unique constellation of anxiety symptoms), triggered by a substance or medication. The symptoms (i.e. restlessness, worry, muscle tension, rapid heartbeat, etc.) are at least as distressing as when they occur organically or via some environmental stimulus, and can be confusing or surprising to the person suffering the mental health conditions, and to their friends and family. Substances that can induce anxiety disorders include, but are not limited to, alcohol, stimulants such as caffeine or amphetamines, hallucinogens, cannabis, antihistamines, blood pressure meds, opiods, steroids, and psychiatric meds.
Panic Disorder (with and without Agoraphobia)
Panic disorder is an anxiety disorder in which you experience recurrent panic attacks and concern about future panic attacks. Panic attacks are a sudden onset of fear or discomfort, along with a number of distressing physical symptoms, including rapid heartbeat, sweating, trembling or shaking, shortness of breath, a feeling of choking, chest pain, nausea, dizziness/lightheadedness, chills or hot flushes, numbness or tingling, feelings of unreality or detachment from oneself, fear of “going crazy,” and/or fear of dying. These symptoms often seem to come out of the blue and reach their peak within a few minutes. It can take some time for the symptoms to completely dissipate. Panic Disorder was one of the first disorders I ever treated, while training to be a psychologist, and although frightening, this is a particularly treatable disorder because of the very concrete steps you can take to overcome the anxiety symptoms. Panic Disorder can occur with or without Agoraphobia. Agoraphobia is a condition in which the individual suffering is fearful of leaving the house because they fear experiencing a panic attack.
Specific Phobia
Specific phobia is a group of anxiety disorders in which you experience an irrational and intense fear of a certain object or situation, and may go to great lengths to avoid the object of the phobia. If it cannot be avoided, it is endured with extreme distress. Phobias are different from fears, and the DSM-5 highlights the following unique criteria: immediate and disproportional anxiety response, avoidance or extreme distress, interference in everyday life, and at least six months’ duration. The most common types of phobia can be fear of a natural or environmental phenomenon, injury, animals (e.g. spiders, snakes), or certain situations (e.g. claustrophobia—fear of enclosed spaces).
Social Anxiety Disorder
Social anxiety disorder is an anxiety disorder in which you experience persistent and intense anxiety or fear about specific social situations, and believe that you may be negatively perceived or judged. Similar to phobias, this fear is out of proportion to the situation, interferes with daily life, and results in either avoidance of social situations or tolerating them with extreme distress. It is easy to confuse Social Anxiety Disorder and Agoraphobia, and the main difference is that people with Social Anxiety Disorder fear embarrassment and/or judgment, while those with Agoraphobia fear the onset of a panic attack. Please note that Social Anxiety Disorder used to be known as Social Phobia, and some of its symptoms do line up with symptoms specific to phobias.
Obsessive-Compulsive Disorder
Obsessive-Compulsive Disorder (OCD) is an anxiety disorder in which you experience recurrent and persistent thoughts, urges, or images that are intrusive, unwanted, and trigger significant anxiety or distress. The authors of the DSM-5 note that individuals suffering from OCD use specific thoughts or actions in an attempt to ignore or suppress the intrusion. Obsessions are generally the thoughts that cause distress, and compulsions are the behaviors that can either cause distress, or are used to mitigate the distress triggered by the obsessive thoughts. In my experience, clients with OCD spend a great deal of time trying to counteract their obsessions or compulsions, and can be quite preoccupied, therefore unable to engage in critical aspects of their lives. In fact, the DSM-5 states that, in order to be diagnosed as OCD, the OCD-related behaviors must take more than an hour a day, and/or cause significant distress or impairment in one’s life.
Other Anxiety Disorders
Other anxiety disorders include Post-Traumatic Stress Disorder (PTSD) and Acute Stress Disorder, Separation Anxiety Disorder, and Selective Mutism. PTSD is a long-term reaction to a traumatic event (or series of events), in which the sufferer often mentally re-experiences the event, may experience hypervigilance, and/or have a sense of a foreshortened future. Acute Stress Disorder is a similar constellation of symptoms that occurs immediately following the traumatic event. Separation Anxiety Disorder is primarily present in children, and includes a host of uncomfortable symptoms when the individual is separated from their primary caregiver. Finally, Selective Mutism (also primarily present in children) is when an acute anxious response to an event may cause an individual to stop speaking for an unspecified period of time. I’ve observed, as a psychologist, that many clients come in for one disorder and, after doing some insight-oriented work, find that they are also experiencing effects of trauma, if not PTSD itself.
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How is Anxiety Diagnosed?
Anxiety disorders are generally diagnosed after a clinical interview with a qualified mental health professional, usually a psychologist or psychotherapist. The clinician will conduct a thorough interview, gathering history, current symptoms, trajectory of symptoms, and severity of distress and impairment, and make a diagnosis. During this interview, I often encourage the client to provide as much detail as they comfortably can, and ask plenty of questions. Mental health providers rely on the DSM-5 to make their diagnosis, and refer to the symptom lists to rule certain diagnoses in or out.
How to Reduce Anxiety Immediately?
The most effective way to quickly reduce anxiety is to learn deep breathing or relaxation techniques. These can be a form of meditation, or simple exercises that can be done in the car or your home in just a matter of minutes. I’ve taught clients to do these exercises in just a few moments, and they’ve enjoyed the alleviation of symptoms for years to come (feel free to watch this video with instructions on how to do deep breathing; here for meditation). When anxiety is activated, it is a sign that your sympathetic nervous system (i.e. fight, flight or freeze) is aroused, and the best way to shut down the sympathetic nervous system is to activate your parasympathetic nervous system (i.e. rest and digest). Deep breathing and muscle relaxation are the quickest, most effective ways to accomplish this goal. And notably, when you develop proficiency with these techniques, you may find that you manage stress better, which is a win all the way around.
What are the Best Therapy Options for Anxiety Treatment?
The best ways to treat anxiety are Cognitive Behavioral Therapy (CBT), Acceptance and Commitment Therapy (ACT), exposure therapy (including Exposure and Response Prevention—ERP), and medications.
CBT
CBT is a highly effective talk therapy in which you learn techniques that help you change the way you think, particularly about anxiety-provoking situations or objects. As you learn to think differently, your feelings adjust in kind, and anxiety reduces.
ACT
ACT focuses on adjusting your behaviors to help train your brain to respond differently to those anxiety-inducing stimuli, thereby reducing anxiety. This is my go-to anxiety treatment, and have seen clients enjoy very positive results.
Exposure Therapy
Exposure therapy uses clinical guidance to treat anxiety by helping you gradually gain comfort with your anxiety-provoking stimuli by slowly exposing you to it in safe and manageable doses. ERP (Exposure and Response Prevention) is used specifically for OCD, and is the clinical gold standard for OCD treatment.
Medication
While these therapy options treat anxiety by helping to reduce the psychological symptoms of anxiety, medication can more quickly target the physical symptoms, helping bridge the gap until the benefits of behavioral and talk therapy thoroughly manifest.
How Does Cabot Treat Anxiety?
Cabot’s highly-trained clinicians use cognitive behavioral therapy, acceptance and commitment therapy, exposure therapy (including ERP), and referrals to prescribers to treat clients that come to us with anxiety. Research has shown that these are the most effective ways to treat anxiety, and we believe in evidence-based practices. We have seen countless clients decrease their symptoms and increase their quality of life because they’ve learned to think differently, adjust their behavior, or increase their comfort with situations or objects that have previously been a debilitating source of anxiety. We often work in conjunction with psychiatrists, nurse practitioners, or general physicians to help manage medication. We find that medication can often help provide relief until the work being doing in therapy really starts to benefit the client.
Side Effects
The side effects of therapy for anxiety primarily include a short-term, temporary increase in discomfort. It is hard to make change! Especially when you’re changing long-standing thought patterns, or exposing yourself to situations or objects that trigger intense discomfort. Because of this, our therapists at Cabot work within your comfort level to help you develop a safe starting place, techniques to immediately decrease symptoms of anxiety (link here to “How to reduce anxiety immediately”), and a trusting relationship with your therapist. We will never push you beyond a manageable level of discomfort, and we know that the discomfort will pay off in a decrease in symptoms.
Meditation for Anxiety
Many clients at Cabot have experienced lasting change as a result of going through therapy for anxiety. One client felt that she “got [her] life back” after years of being unable to drive in her car. Another client was “finally” able to go into public places without fear of having a panic attack. Still another was able to experience intimacy again after battling their symptoms of OCD. This is just a small sampling of the changes that anxiety treatment can beget. Although challenging, therapy usually pays off with an improvement in quality of life.
Client & family testimonials
"Sessions with Amanda are empowering.
Sessions with Amanda are empowering. She is a deeply kind therapist who has helped me to process, heal, and develop as a person.
—Kelly
"I have been a client of Cabot since the inception in 2010
I have been a client of Cabot since the inception in 2010; my experience with the therapists and administrative staff have always been positive. I trust them and have referred both family and friends to Cabot and all have come back thanking me for the referral and have benefited from the caring and compassionate work of the Cabot staff.
—KM
"Cabot provides a welcoming and safe environment
Cabot provides a welcoming and safe environment for those who may be struggling or need additional support. Each time I come for an appointment I am welcomed with a smile and hello not only from my therapist but others who pass through the waiting room.
—KG
What are the Challenges of Treating Anxiety?
The most challenging part of treating anxiety disorders is the necessity of facing the things that have made you anxious, often for many years of your life. It takes a great deal of bravery to take this step and recognize that your life is being negatively impacted, and to acknowledge that there are people who have learned how to help. Licensed therapists can attest to the discomfort of clients facing down anxiety, but the reward is being able to face it with less fear and/or anxiety. As a client, you get to enjoy that reward for the rest of your life.
How Effective is Therapy for Treating Anxiety?
Anxiety disorders are eminently treatable. The National Institute of Health, in a meta-analysis of CBT with anxiety disorders, concluded that CBT is “highly effective.” According to a website focused on the treatment of OCD, ERP (exposure and response prevention) has a success rate of 65-80% in children, adolescents and adults with OCD. Although anxiety disorders cause extremely high levels of distress, the prevalence of physical symptoms allows clinicians to use some very effective and concrete techniques to provide relief, which then paves the way for the longer-term therapies like CBT, ACT and exposure therapy. As a psychologist, I find that anxiety disorders are among the most treatable of all the diagnoses.
FAQs on Anxiety
Cognitive behavioral therapy (CBT) is the most commonly used therapy for anxiety. CBT uses the brain’s power and flexibility to challenge maladaptive thoughts about anxiety-inducing stimuli, and introduce more accurate thoughts that decrease the fearsome-ness of the targeted stimuli.
Anxiety therapy varies in the amount of time it takes to experience a decrease in symptoms. Some people enjoy at least some relief immediately, upon learning some simple relaxation techniques. Most people require at least a couple months of regular therapy to get more long-lasting relief, and some people, particularly those with long-standing symptoms, need more time. Even those who require longer-term therapy for anxiety disorders often have at least a reduction of symptoms in the first months of therapy.
The success rate of therapy for anxiety disorders varies by diagnosis. According to the Society of Clinical Psychology, PTSD and GAD have the highest remission rates (over 50%) and social anxiety and OCD have the lowest rates (around 40%). These success rates are highly dependent on the quality of care provided by the clinician and the level of investment by the client.
Any number of stimuli can trigger an anxious response, but because of the highly physiological manifestation of anxiety, it is often a physiological phenomenon that can trigger a reaction. For example, an individual with panic attacks may get triggered by an elevated heart rate, as their brain may correlate a rapid heartbeat with panic. However, for those with situation- or object-specific anxiety disorders, it is often the situation or object itself that triggers the reaction (e.g. individuals with social anxiety get triggered by social events, individuals with arachnophobia are triggered by spiders).
When Should I Seek Medical Care for My Anxiety?
The DSM-5 cites distress and interference as the boundary between “normal” anxiety and diagnosable anxiety disorders. If anxiety is starting to cause you high levels of distress, or interfere with your life in significant ways, it is time to seek help. Oftentimes, you may get feedback from others that you have made maladaptive adjustments that you were unaware of, and it can be helpful to listen to those that care about you. The first step may be to seek out a licensed therapist in your area, with an expertise in anxiety. You may always request an initial consult to get a feel for the therapist, and help establish whether they may be a good fit for you. Clinical research indicates that feeling comfortable, or having rapport, with your therapist is an important factor in experiencing success in therapy. (Click here for a video on how to go about finding the therapist that is right for you.)
Anxiety Treatment at Cabot
All the clinicians at Cabot are trained in treating anxiety disorders, and we prioritize providing a comfortable, welcoming space for you to face this challenging diagnosis. We want to hear you, understand thoroughly what you’re facing, and then work with you to develop a treatment plan to overcome your anxiety. We will never push you beyond your tolerable comfort levels, and will honor you and your values throughout the course of treatment.