| An anxiety
disorder may make you feel anxious most of the time, without any
apparent reason. Or the anxious feelings may be so uncomfortable that to
avoid them you may stop some everyday activities. Or you may have
occasional bouts of anxiety so intense they terrify and immobilize you.
Anxiety disorders are the most common of all the mental health disorders. Considered in the category of anxiety disorders are: Generalized Anxiety Disorder, Panic Disorder, Agoraphobia, Social Phobia, Obsessive Compulsive Disorder, Specific Phobia, Post-Traumatic Stress Disorder, and Acute Stress Disorder. Anxiety disorders as a whole cost the United States between 42-46 billion dollars a year in direct and indirect healthcare costs, which is a third of the yearly total mental health bill of 148 billion dollars. In the United States, social phobia is the most common anxiety disorder with approximately 5.3 million people per year suffering from it. Approximately 5.2 million people per year suffer from post-traumatic stress disorder. Estimates for panic disorder range between 3 to 6 million people per year, an anxiety disorder that twice as many women suffer from as men. Specific phobias affect more than 1 out of every 10 people with the prevalence for women being slightly higher than for men. Obsessive Compulsive disorder affects about every 2 to 3 people out of 100, with women and men being affected equally. Many people still carry
the misperception that anxiety disorders are a character flaw, a problem
that happens because you are weak. They say, "Pull yourself up by
your own bootstraps!" and "You just have a case of the
nerves." Wishing the symptoms away does not work -- but there are
treatments that can help. Today, much more is known about the causes and treatment of this mental health problem. We know that there are biological and psychological components to every anxiety disorder and that the best form of treatment is a combination of cognitive-behavioral psychotherapy interventions. Depending upon the severity of the anxiety, medication is used in combination with psychotherapy. Contrary to the popular misconceptions about anxiety disorders today, it is not a purely biochemical or medical disorder. There are as many potential causes of anxiety disorders as there are people who suffer from them. Family history and genetics play a part in the greater likelihood of someone getting an anxiety disorder in their lifetime. Increased stress and inadequate coping mechanisms to deal with that stress may also contribute to anxiety. Anxiety symptoms can result from such a variety of factors including having had a traumatic experience, having to face major decisions in a one's life, or having developed a more fearful perspective on life. Anxiety caused by medications or substance or alcohol abuse is not typically recognized as an anxiety disorder. We have developed the information here to act as a comprehensive guide to help you better understand social anxiety disorders and find out more information about them on your own. The causes of social phobia and its treatment are similar to those of agoraphobia and simple phobia. Medications for this and other phobic disorders have been useful in two contexts. First, the minor tranquilizers or anxiolytics are excellent means of treating anxiety symptoms. However, they do not appear to block the actual process of panic attacks. Second, certain of the tricyclic antidepressants have been used in some patients, often in doses well below those used for the Affective Disorders. Considerable success in controlling panic attacks, with and without agoraphobia, has been reported in recent years through the use of tricyclic antidepressants, especially imipramine (Tofranil, Geigy), and monoamine oxidase inhibitors (MAOI's), such as phenelzine (Nardil, Parke-Davis). The dramatic reduction in panic attacks that follows such medication is the central factor in recovery from agoraphobic disorders. Sometimes the mere control of the panic is sufficient to allow patients to resume their customary activities. If anticipatory anxiety persists despite the disappearance of the acute panic attacks, benzodiazepines or behavioral desensitization or both are required to combat this more chronic form of anxiety. In addition, insight psychotherapy should be considered for those patients who fulfill the criteria for this form of treatment; with the acute, disabling symptoms under pharmacological control, such patients may be helped to resolve the psychological conflicts that frequently play a significant role in producing the surface symptoms. Imipramine will block some panic attacks and clomipramine (not yet available in the United States) is a promising drug; however, the latter appears of more use in Obsessive Compulsive Disorder and both have significant side effects. The MAO inhibitors are helpful for some patients. Anti-anxiety Drugs The minor tranquilizers have a particularly important place in the treatment of the phobic disorders. Chlordiazepoxide (Librium) and diazepam (Valium) are both effective aids to the patient in his struggle with the phobic situation if they are taken in sufficient doses to produce a relaxation of tension and musculature. Other Drugs For a specific but severely debilitating social phobia such as stage fright in a professional performer, beta-adrenergic blocking agents may be prescribed. In the case of an agoraphobic patient, the clinician might have the patient imagine (perhaps in hypnotic trance, but this does not seem to add to the effectiveness of treatment) taking a fearful trip, remaining in the anxiety-producing fantasy as long as possible, then "returning" to the therapist's office. This is repeated a number of times, and the patient is instructed to perform the same exercise as often as possible between sessions. Family members are frequently engaged to assist in the process and monitor the "homework." Written journals and diaries may also be used. In most patients, panic attacks can be treated at the same time, in the same way. Sometimes attention to the physiologic cues of panic or mounting anxiety helps the patient to recognize and control panic symptoms. Psychotherapy can be a useful part of the treatment of the anxious or phobic patient. The term "psychotherapy" implies a wide variety of kinds of therapist-patient interaction, overlapping considerably with the behavioral treatments. It is almost impossible to work with a patient in any context without providing considerable interest, support, and understanding. Beyond this, the patient who has given up a symptom may suffer feelings of loss for the symptom itself, for the "equilibrium" of life-style which has existed surrounding the symptom, or both. The opportunity for continuing counseling may be valuable. Those patients who do not respond to the briefer treatments often benefit from more in depth psychodynamic psychotherapy. The typical patient after such treatment was in better condition than 77% of untreated controls evaluated at the same time. The various modes examined included psychodynamic, cognitive, and humanistic, as well as behavioral and social, therapies. The behavioral technique of "exposure" is an effective treatment, both short- and long-term, for agoraphobics and many other phobia patients. The use of exposure in fantasy, presenting increasingly anxiety-producing situations as discomfort dissipates at each level, is a form of systematic desensitization. Exposure in vivo also involves gradual adaptation to anxiety-producing objects or situations, but the objects or situations are actually present during the treatment. Flooding, rapid exposure to almost overwhelming volumes of phobic material, also known as implosion, may be used either in fantasy or in vivo. In general, the behavioral treatments, perhaps coupled with appropriate psychotherapy, have the greatest likelihood of effectiveness, and should be tried before medication is prescribed on any chronic basis. References: |