by Jeffrey B. Roth
Worry, stress and anxiety are common emotions people experience during the winter holidays and throughout the year.
Those three words are often used interchangeably, but to mental health and medical professionals, anxiety is a clinical term that classifies a diagnosable range of mood disorders affecting a quarter of the U.S. population, at some point in their lives, according to Karen L. Cassiday, president of the Anxiety and Depression Association of America.
“One thing we know is that anxiety disorders are the largest class of (mental) disorders that affect Americans,” said Cassiday, who has appeared as an expert on TNT’s “Animal Hoarders” and the “Today Show” on NBC.
“When we look at youth, age 35 and younger, what we are seeing is that over the past 30 years, rates of anxiety and depression have been increasing,” Cassiday added. “We think it has to do with a culture of overprotection, where youth are not getting the opportunities they need during their development to handle stress, disappointment, mistakes—things like that. Also, anxiety and depression are close cousins, with a comorbidity rate as high as 70 percent…and children who have severe anxiety at a young age are at high risk for developing bipolar disorder.”
Anxiety disorders affect 40 million adults in the country, according to the National Institute of Mental Health.
The annual cost of anxiety disorders is estimated at $42 billion per year, and account for nearly one-third of the country’s $148 billion annual mental health bill, according to the Anxiety and Depression Association.
Experiencing stress or worry is nearly a universal experience, Cassiday said. People with anxiety disorders often react with dread to simple stress.
They view anxiety as uniquely negative, (known as anxiety sensitivity or the fear of being afraid); as something they must worry about and question; as compared to an individual without an anxiety disorder, who attributes it to a benign cause and shrugs off the experience with an “Oh well.”
Jodie Foster, a Western Maryland College (McDaniel College) graduate, who is a licensed clinical professional counselor, with a practice based in Westminster, said an anxiety disorder differs from normal worry, in terms of duration, severity and types of symptoms. Anxiety disorder classifications include generalized anxiety disorder, anxiety attacks (panic disorder), obsessive-compulsive disorder, phobia, social anxiety disorder, and post-traumatic stress disorder.
“Generalized anxiety disorder is diagnosed when a person experiences anxiety in response to a wide variety of situations,” Foster said. “An individual could be given the diagnosis of panic disorder if attacks are frequent and recurrent and also accompanied by worry about additional panic attacks or maladaptive changes in behavior, (i.e. avoiding situations in which the person is fearful an attack may occur).”
Obsessive compulsive disorder involves the presence of obsessions and/or compulsions, often accompanied by ritualistic behaviors, such as counting. Phobias involve fear or anxiety about a specific object or situation, Foster said. Social anxiety disorder is fear or anxiety about social situations where individuals fear being negatively evaluated by others. PTSD results from experiencing or witnessing a terrifying event and may involve intrusive symptoms such as recurrent distressing memories of the event, recurrent distressing dreams, flashbacks and severe anxiety.
“I primarily utilize cognitive-behavioral techniques as well as play therapy when treating anxiety disorders,” Foster said. “Cognitive-behavioral therapy also helps clients to identify their maladaptive thoughts and/or beliefs about themselves, others, and the world around them and then replace those with more healthy ones.”
Pastorally-trained counselor, Stephnie Thomas, whose private practice is located in Westminster, is also a staff member of the Anxiety and Stress Disorders Institute of Maryland, which maintains an office in Towson. She works with anxiety disorder clients ranging in age from eight to 84. Specializing in treating clients with OCD, she also developed a fear of flying program at ASDI.
“I offer therapy from a cognitive behavioral approach, using evidence-based techniques like ACT, (Acceptance and Commitment Therapy), mindfulness, etc., where appropriate,” Thomas said. “As a counselor trained in Loyola’s Pastoral Counseling program, I respect and incorporate the client’s religious/spiritual beliefs—something that is really important to many people in our area.”
At her practice in Westminster, Thomas said that during the last six months, she has witnessed an increase in the number of residents seeking treatment for anxiety disorders.
Thomas isn’t sure whether that observation means that anxiety disorders are on the rise in Westminster, or people are more open to seeking treatment today, than in the past.
“The International Obsessive Disorder Foundation, (IOCDF), recommends the use of a combination of ERP, (Exposure and Response Prevention), and CBT for the effective treatment of OCD,” Thomas noted.
“This is considered the gold standard of treatment amongst the professionals and researchers, who are constantly working to improve treatment outcomes for those who suffer with this horrible disease,” she added. “There is some exciting research that indicates that combining ERP with ACT, along with appropriate medications, is helping formerly treatment-resistant clients overcome their compulsions.”
Normal anxiety functions as a natural defense system by alerting the body to a potential threat, Thomas said. The job of the brain’s prefrontal cortex is to control excessive anxiety by moderating the activity of the amygdala. When the prefrontal cortex-amygdala connection is weak or faulty, the amygdala may overreact and release too large of a dose of the stress hormone, cortisol, and adrenaline, causing a panic attack.
Pyschologist David J. Raznick, founder and director of Carroll Counseling Centers, located in Eldersburg and Mt. Airy, has spent more than 30 years working with youth and adults diagnosed with a broad spectrum of mental health issues. For the past 10 years, he has been working more with an adult population, treating them for depression, anxiety, bipolar disorder, personal and relationship issues and other transitional problems.
“Stress is probably the fifth leading reason for major medical issues,” Raznick said. “A vast majority, probably over 60 to 65 percent of people who go to primary care doctors have underlying-related stresses. They don’t go there and say: ‘I’m here because of stress.’ The way it shows up is high blood pressure, heart disease, as a contributor to diabetes and affects the quality of sleep. A lack of quality sleep weakens the autoimmune system.”
Normal stress-related anxiety may function as a motivation to meet deadlines or deal with other challenges. Temporary stress and anxiety go away, Raznick said. Symptoms associated with anxiety disorders are persistent and may interfere with social, professional, familial and other life relationships.
What should you do if you’re experiencing severe anxiety: “reach out to a professional,” Raznick said. “Some primary care doctors are very good and will consider using FDA-approved medications to treat anxiety disorders. Not for every anxiety disorder, do you reach for medication. We have to be very judicious in how we use medication.”
Cognitive behavioral therapy can be a very effective treatment for anxiety disorders because it deals with ways of thinking about life-related challenges and stresses, Raznick said. Thinking drives emotional states.
Raznick said the book: “Feeling Good: The New Mood Therapy,” by David Burns, provides an excellent summary about common thinking errors. Burns assigns thinking errors to 10 categories: all-or-nothing thinking, overgeneralizing, filtering out the positive, mind-reading, catastrophizing, emotional reasoning, labeling, fortune-telling, personalization and unreal idea.
