Our prehistoric ancestors knew how to deal with anxiety. If a threat appeared, their bodies and minds would rev up to respond. Once the threat was gone, they returned to their usual activities and behaviors. Unfortunately, modern life isn’t quite so black and white. Stress, worry and uncertainty can bombard us from all sides, and that kind of ongoing anxiety can cause a range of problems.
“There are three types of anxiety,” says local psychiatrist Dr. Andrea Wilson. “ ‘In the head’ anxiety is exemplified by generalized anxiety disorder and also obsessive-compulsive disorder. ‘In the body’ anxiety is exemplified by the panic attack. And the ‘really bad things happened to me’ anxiety is exemplified by PTSD (post-traumatic stress disorder).”
In the case of generalized anxiety disorder, “the experience of the person is really dominated by their thoughts and by the anxiety in those thoughts,” Wilson says. This type of anxiety differs from the type that results in panic attacks, which involves an acute burst of physical symptoms. “There’s action in the head with thoughts about death or going crazy” during a panic, Wilson notes. However, these individuals typically report a racing heart, sweating and breathlessness. The symptoms can mimic a heart attack and send patients to the emergency room.
“Generalized anxiety disorder characterizes a level of anxiety worry that is pervasive, debilitating and of long duration,” notes Dr. Gregg Bassett, a psychiatrist with Allied Behavioral Consultants. “It is really bad and really long-lasting, and it affects many areas of functioning. The concept is really trying to capture someone who is debilitated by worry as opposed to the ‘fight or flight’ symptoms, which characterize the symptom cluster known as a panic attack.”
Bassett notes that typical anxiety produced by everyday stressors is different from the type of anxiety that brings people to his office. “I think it is fair to say that a patient is likely to have a diagnosable anxiety disorder if he or she is feeling bad enough to make and keep an appointment with a mental health professional,” he says.
Worry over stressful events, such as a big game or job interview, is not unusual. “However, you might need to see a psychiatrist if you are so consumed with worry about the softball league and about your finances and about the fact that you have to negotiate a dangerous stretch of I-70 every day that, for the better part of six months, you cannot stop thinking about those things, cannot sleep, always feel tense and regularly yell at anyone within earshot,” Bassett says.
Wilson adds that distinguishing between the primary threat and the ongoing thoughts that amplify that threat is key. People can and should learn to manage that lingering anxiety, although techniques to do so are not taught or practiced widely in our society. Thus, some people turn to alcohol, drugs or food to help quell their emotions. “This is self-punishment,” Wilson says. “Any message a person gives himself that this will help anxiety is a lie.”
Similar to the treatment of major depressive disorder, a combination of prescription medication and psychotherapy is often the most effective approach for those diagnosed with an anxiety disorder. Cognitive behavioral therapy can provide specific tools, such as breathing exercises, that patients can use when they begin to feel especially anxious.
Dr. William Kelly, a psychoanalyst and clinical professor of psychiatry at Saint Louis University, uses dynamic, insight-oriented psychotherapy for his patients. This involves a long-term process of delving into childhood experiences and a “gradual coming to grips” with the past.
“You are supposed to, within reason, be anxious about a big presentation or a first date or that upcoming playoff game,” Bassett says. “Life is about balance and moderation. If your worry becomes so pervasive, so long-lasting and so frequent that it causes your life to become ‘unbalanced,’ then it is probably time to get some help.”