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October 8, 2020
We, as humans, need anxiety. Why? Anxiety is information.
It tells us when we must freeze, flee, or fight and mobilizes our body to respond quickly, without thinking. Without anxiety, we would not be able to avoid real threats to our well-being.
However, we also feel anxiety about imagined threats that may or may not be meaningful or real. In a sense, our minds have evolved to be extra careful about threat detection. They are more likely to evaluate things as threats than not. This way we do not miss anything that might harm us.
Also, our minds do not have an “off button.” This means that sometimes anxiety becomes a problem because it doesn’t give us useful information and contributes to our distress and avoidance.
All humans experience anxiety when they experience stressful events, such as receiving an upsetting medical diagnosis. Public speaking, social events, relationship problems, stress on the job, and financial worries are also common triggers that make people feel anxious. However, sometimes life events can trigger anxiety disorders or panic disorder. So, what’s the difference?
Your social media feed is full of divisive political talk, there are risks of layoffs due to the decimated economy, and there seems to be no clear end in sight.
In the meantime, you have a project deadline tomorrow.
You feel stressed, squeezed, and overwhelmed. You feel tired and worried, unsure about what the future holds, whether you will get done what you need to do, whether you will help your child cope with it all.
It is the middle of the night, and you can’t go to sleep. Your thoughts are racing.
What if …? Your mind can’t stay away from the stream of catastrophic worries that keep circling. Your heart pounds. You’re exhausted. You look at the clock—it’s 3:15am.
You’re out with your friends at a restaurant, laughing at a joke one has just told.
All of a sudden, there’s a sensation of your blood rushing to your ears, and your heart rate accelerates. Your hands are clammy, and you wonder whether you’re having a heart attack.
Intense fear grips you, and you feel the urge to leave, to escape the situation. You get up without excusing yourself and run for the door.
Understanding the differences between naturally occurring anxiety, worry, and panic can help people take steps to address their feelings. Knowledge of these conditions can also help individuals recognize if their condition is serious enough to require treatment.
This describes an individual experiencing very natural, understandable anxiety around a challenging situation. Fear of an uncertain future, memories of a difficult past, threats (both real and perceived), and confusion about the world around us are all triggers for anxiety.
The second example describes an individual experiencing worry and depending on the level of distress and functional impairment caused, may indicate that treatment for anxiety might be helpful.
Worry is a mental activity that, somewhat counterintuitively, functions as an anxiety avoidance strategy, though it’s one that doesn’t work very well. It’s hard to simply stop worrying.
Typically, when individuals find themselves stuck in a worry cycle, learning acceptance and mindfulness skills from acceptance-based behavior therapy can be useful.
This is an individual experiencing a panic attack. Panic attacks are rarer and more severe than anxiety. They can come out of the blue, without warning or provocation.
People having panic attacks can experience shortness of breath, dizziness, nausea, and numbness. Some shake and sweat. Individuals struggling with panic often are very watchful for the physical sensations that might be harbingers of panic and avoid places where panic attacks may have occurred in the past. Sometimes those struggling with panic avoid leaving their homes at all.
The good news is that panic disorder is highly treatable with exposure therapy.
The Anxiety and Depression Association of America reports that some 40 million U.S. adults experience significant anxiety each year, with more than 28.8% of adults experiencing clinically meaningful anxiety symptoms.
That’s nearly one in three people.
Anxiety is America’s most common mental illness and can be treated effectively. However, only around one third of those with the condition seek professional help.
Anxiety disorders are hereditary, which means that if you have a relative with anxiety, you are more likely to experience it yourself.
Panic disorder, which is a type of anxiety disorder, affects about 4.7% of U.S. adults at some point in their lives, according to the National Institute of Mental Health.
We know that anxiety disorders are maintained by avoidance. For example, if you are afraid of dogs, you avoid them. While this keeps you safe in the moment, it also feeds your fear because it takes away any opportunities you may have to learn more about dogs—that while some bite, others are cuddly, empathic, and silly.
If you are experiencing anxiety that has been prolonged, causes you significant distress, or impairs your ability to function, it may be time to seek help. The good news is that effective treatment is available in a variety of forms.
Although there are different ways to approach anxiety treatment, we know that exposure therapy has proven to be incredibly helpful. At the heart of the approach is tackling problematic avoidance and increasing willingness to experience discomfort.
Sometimes medications are used to augment exposure-based treatment for anxiety. Serotonin reuptake inhibitors (SRIs) and other antidepressants may be useful here to help individuals better engage in exposure-based work.
Newer treatments, like mindfulness-based cognitive therapy, meditation, and acceptance-based approaches, like acceptance and commitment therapy, have also been shown to be effective.
Finally, maintaining healthy behaviors, such as regular physical exercise, good sleep hygiene, and avoiding the use of alcohol or caffeine, can also be helpful.
Unlike anxiety, which often has clear triggers, panic attacks occur suddenly and unexpectedly and typically only last for a few minutes.
Those who experience panic attacks have reported lightheadedness, chest pain, hot flashes, chills, and stomach discomfort. Some say they feel like they were being choked or suffocated. Others say an attack made them feel “detached from reality.”
Occasional panic attacks can happen to anyone, although for some individuals, they occur more frequently and cause significant distress and impairment.
Evidence-based treatments for panic disorder are similar to those for anxiety and involve exposure-based treatment. Mindfulness and meditation can also be useful to curb stress and promote increased psychological flexibility.
Sometimes medications are used to augment behavioral treatments for panic disorder and include beta-blockers, selective serotonin reuptake inhibitors, and serotonin-norepinephrine reuptake inhibitors.
If you have had continued panic attacks, you may need to seek professional help. Your doctor will ask about your symptoms, other mental health and medical conditions, and whether you are experiencing abnormal stress or anxiety. Blood tests and a heart examination may also be required.
Both panic and anxiety are treatable and manageable—even when they may feel as if they are out of your control.
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