Anxiety: Strategies to Reduce Excessive Worry and Irrational Fear

Anxiety can be defined as experiencing intense feelings of fear, dread or apprehension that have not been connected to a specific danger or identified threat. The word “anxiety” originates from the Latin word anxius, which is a state of agitation and distress (Brantley, 2003).

Most all of us experience feelings of anxiety or nervousness on occasion. This is perfectly normal. However, when excessive fear causes significant impairment in daily functioning, a person may consider scheduling an appointment with a mental health provider to evaluate the presence of an anxiety disorder.

Common Symptoms of Anxiety:
-Excessive / uncontrollable worry about events
or activities (such as work or school performance).
-Feeling on edge or keyed up
-Worry excessively about acting / speaking more
aggressively than you should
-Being easily fatigued
-Difficulty concentrating or mind going blank
-Irritability
-Muscle tension
-Sleep disturbance (difficulty falling or staying
asleep, or restless unsatisfying sleep)
-Is afraid of being around other people
-Has fear of performing
-Tries to avoid social situations (If unavoidable,
feels awful)
-Fear interferes with (sleep, school, activities)
-Feels very uncomfortable because of fear
-Feels that behavior does not make sense (e.g.,“why do I have to worry about this when it seems like other people don‟t”)


Phobic object/situation: When confronted with object/situation:
-Gets uptight and scared, can‟t move
-Cries, clings to parents, throws tantrums
-Avoids object/situation
-Becomes nauseated, feels faint
-Fear interferes with (sleep, school, activities)
-Feels super uncomfortable because of fear
-Is more scared of object/situation than peers
-Fear seems silly to person
Strategies To Cope with Anxiety
According to The National Institute of Mental Health (NIMH 2011)
Psychotherapy: involves talking with a trained mental health professional, such as a psychiatrist, psychologist, social worker, or counselor to discover what caused an anxiety disorder and how to deal with its symptoms.
Cognitive Behavioral Therapy (CBT): is very useful in treating anxiety disorders. The cognitive part helps people change the thinking patterns that support their fears and the behavioral part helps people change the way they react to anxiety-provoking situations.
As an example, CBT can help people with panic disorders learn that their panic attacks are not really heart attacks and help people with social phobia learn how to overcome the belief that others are always watching and judging them.
When people are ready to confront their fears, they are shown how to use exposure techniques to desensitize themselves to situations that trigger their anxieties. People with OCD who fear, dirt and germs are encouraged to get their hands dirty and wait increasing amounts of time before washing them. The therapist helps the person cope with the anxiety that waiting produces; after the exercise has been repeated a number of times the anxiety diminishes.
People with social phobia may be encouraged to spend time in feared social situations without giving in to the temptation to flee and to make small social blunders and observe how people respond to them. Since the response is usually far less harsh than the person fears, these anxieties are lessened. People with PTSD may be supported through recalling the traumatic event in a safe situation, which helps reduce the fear it produces. CBT Therapists also teach deep breathing and other types of exercises to relieve anxiety and encourage relaxation.
Exposure-based behavioral therapy has been used for many years to treat specific phobias. The person gradually encounters the object or situation that is feared. The object or situation that is feared perhaps at first through pictures or tapes, then later face-to-face. Often the therapist will accompany the person to a feared situation to provide support and guidance. CBT is undertaken when people decide they are ready for it and with their permission and cooperation. To be effective, the therapy must be directed at the person’s specific anxieties and must be tailored to his or her needs. There are no side effects other than the discomfort of temporarily increased anxiety.
CBT or behavioral therapy often lasts about 12 weeks. It may be conducted individually or with a group of people who have similar problems. Group therapy is particularly effective for social phobia. Often homework is assigned for participants to complete between sessions. There is some evidence that the benefits of CBT last longer than those of medication for people with panic disorder and the same may be true for OCD, PTSD, and social phobia. If a disorder recurs at a later date, the same therapy can be used to treat it successfully a second time. Medication can be combined with psychotherapy for specific anxiety disorders, and this is the best treatment approach for many people.
Medication: will not cure anxiety disorders, but it can keep them under control while the person receives psychotherapy. Medication must be prescribed by physicians, usually psychiatrists who can either offer psychotherapy themselves or work as a team with psychologists, social workers or counselors who provide psychotherapy.
The principal medications used for anxiety disorders are antidepressants, anti-anxiety drugs, and beta-blockers to control some of the physical symptoms. With proper treatment, many people with anxiety disorders can lead normal, fulfilling lives.
Antidepressants: were developed to treat depression but are also effective for anxiety disorders. Although these medication begin to alter brain chemistry after the very first dose, their full effect requires about 4 to 6 weeks before symptoms start to fade. It is important to continue taking these medication long enough to see them work.
SSRIs: Some of the newest antidepressants are called selective serotonin reuptake inhibitors, or SSRIs. SSRIs alter the levels of the neurotransmitter serotonin in the brain, which like other neurotransmitters helps brain cells communicate with one another.
Fluoxetine (Prozac), sertraline (Zoloft), escitalopram (Lexapro), paroxetine (Paxil) and citalopram (Celexa) are some of the SSRIs commonly prescribed for panic disorder, OCD, PTSD, and social phobia. SSRIs are also used to treat panic disorder when it occurs in combination with OCD, social phobia, or depression. Venlafaxine (Effexor), a drug closely related to SSRIs, is used to treat GAD. these medication are started at low doses and gradually increased until they have a beneficial effect.
SSRIs have fewer side effects than older antidepressants, but they sometimes produce slight nausea or jitters when people first start to take them. These symptoms fade with time. Some people also experience sexual dysfunction with SSRIs, which may be helped by adjusting the dosage or switching to another SSRI.
Tricyclics are older than SSRIs and work as well as SSRIs for anxiety disorders other than OCD. They are also started at low doses that are gradually increased. They sometimes cause dizziness, drowsiness, dry mouth, and weight gain, which can usually be corrected by changing the dosage or switching to another tricyclic medication. Tricyclics include imipramine (Tofranil), which is prescribed for panic disorder and GAD , and clomipramine (Anatranil), which is the only tricyclic antidepressant useful for treating OCD.
Monoamine oxidase inhibitors (MAOIs) are the oldest class of antidepressant medications. The MAOIs most commonly prescribed for anxiety disorders are phenelzine (Nardil), followed by tranylcypromine (Parnate) and isocarboxazid (Marplan), which are useful in treating panic disorder and social phobia. People who take MAOIs cannot eat a variety of foods and beverages (including cheese and red wine) that contain tyramine or take certain medications including some types of birth control pills, pain relievers (such as Advil, Motrin or Tylenol) cold and allergy medications, and herbal supplements; these substances can interact with MAOIs to cause dangerous increases in blood pressure. The development of a new MAOI skin patch may help lessen these risks. MAOIs can also react with SSRIs to produce a serious condition called serotonin syndrome, which can cause confusion, hallucinations, increased sweating, muscle stiffness, seizures, changes in blood pressure or heart rhythm, and other potentially life-threatening conditions.
Anti-Anxiety Drugs: high-potency benzodiazepines combat anxiety and have few side effects other than drowsiness. Because people can get used to them and may need higher and higher doses to get the same effect, benzodiazepines are generally prescribed for short periods of time, especially for people who have abused drugs or alcohol and who become dependent on medication easily. One exception to this rule is people with panic disorder, who can take benzodiazepines for up to a year without harm. Clonzepam (Klonopin) is used for social phobia and GAD, lorazepam (Ativan) is helpful for panic disorder, and alprazolam (Xanax) is useful for both panic disorder and GAD.
Some people experience withdrawal symptoms if they stop taking benzodiazepines abruptly instead of tapering off anxiety can return once the medication is stopped. These potential problems have led some physicians to shy away from using these drugs or to use them in inadequate doses. Buspirone (Buspar), anzapirone, is a newer anti-anxiety medication used to treat GAD. Possible side effects include dizziness, headaches, and nausea. Unlike benzodiazipines, buspirone must be taken consistently for at least 2 weeks to achieve an anti-anxiety effect.
Beta-Blockers such as propranol (Inderal), which is used to treat heart conditions, can prevent the physical symptoms that accompany certain anxiety disorders, particularly social phobia. When a feared situation can be predicted (such as giving a speech), a doctor may prescribe a beta-blocker to keep physical symptoms of anxiety disorder under control.

Before taking medication for an anxiety disorder….
-Ask your doctor to tell you about the effects and side effects of the drug.
-Tell your doctor about any alternative therapies or over-the-counter medications you are using.
-Ask your doctor when and how the medication should be stopped. Some drugs can’t be stopped abruptly, but must be tapered off slowly under a doctor’s supervision.
-Work with your doctor to determine which medication is right for you and what dosage is best. Be aware that some medications are effective only if they are taken regularly and that symptoms may recur if the medication is stopped.
Medication and Psychotherapy: it is important to note that although helpful, medication will not completely cure anxiety disorders. Instead, medication may be used to help improve an individual’s ability to cope with anxiety provoking situations.
Psychiatrists often prescribe medication to help ease anxiety symptoms while the person works with a therapist to learn more adaptive ways of coping with triggers to their anxiety.
For more information, please visit….
http://www.nimh.nih.gov/health/publications/anxiety-disorders/treatment-of-anxiety-disorders.shtml
Warm Regards,


Rich Schlauch, MSW, LISW-CP, LCSW
Palmetto Counseling & Consulting Services, LLC
454 S. Anderson Road
BTC Suite #115 Rock Hill, SC 29730-3392
Phone (803) 329-9639
www.palmettocounselingconsulting.com
email: info@palmettocounselingconsulting.com