Anxiety vs. Anxiety Disorders

In a nutshell, anxiety becomes an anxiety disorder when the anxiety that you are experiencing is greater than what you might expect in a given situation, and when it begins to interfere with some aspect of your life. For example, if your anxiety prevents you from forming desired relationships with people or meeting your responsibilities at work or school, this may be a sign that normal anxiety has shifted to a disorder of anxiety. In addition, if you find that you are engaging in unhealthy behaviors in an attempt to avoid or reduce your anxiety (such as drinking or using drugs), there is a good chance that you have a problem with anxiety.

There are six main anxiety disorders:

Specific Phobia
The first anxiety disorder is specific phobia. In this disorder, people experience such intense fear (even to the point of having a panic attack) when they come into contact with certain objects or situations that they take steps to avoid these objects or situations. Common specific phobias include acrophobia (fear of heights), odontophobia (fear of dentists), arachnophobia (fear of spiders), ophidiophobia (fear of snakes), and claustrophobia (fear of enclosed spaces).

Social Anxiety Disorder
Social anxiety disorder (also called “social phobia”) is another anxiety disorder, in which a person experiences intense fear and anxiety in social situations due to a fear of negative evaluation (for example, being judged). And, just as with specific phobia, this intense fear often results in the avoidance of these social situations. The most common type of situation that people fear in social anxiety disorder is public speaking; however, there are other situations that people with social anxiety disorder may also fear, such as eating in front of people, urinating in public restrooms, or writing in front of people

Panic Disorder
A person with panic disorder experiences frequent, out-­of-­the-blue panic attacks, as well as worry about the meaning or outcome of those panic attacks. For example, people with panic disorder might fear that a panic attack is a sign that they are dying or going crazy. As a result of these panic attacks, people with panic disorder often try to avoid activities or situations that might bring on symptoms of arousal, such as exercise or eating heavy meals. In extreme cases, people with panic disorder may fear leaving home, because it is the only place where they feel safe. If this happens, a person may be diagnosed with panic disorder with agoraphobia.

Obsessive-­Compulsive Disorder
This disorder has received a fair amount of attention in the media recently. In obsessive-­compulsive disorder (OCD), a person experiences intense, intrusive, and repetitive troublesome thoughts and ideas that might be viewed as strange and that are not about real-­life problems. These out-­of-­the-­ordinary thoughts and ideas are called obsessions. For example, people with this disorder may have persistent fears that they are going to accidentally poison their children, catch a disease, or harm someone else. As a result of these obsessions, people with OCD then engage in repetitive behaviors (or compulsions) to reduce the anxiety associated with those obsessions, such as excessive hand washing, ordering, checking, or performing mental rituals (such as counting).

Generalized Anxiety Disorder
Generalized anxiety disorder (GAD) is characterized by excessive, persistent, and uncontrollable worry about many different concerns. Sometimes people confuse GAD with OCD because both include the experience of repetitive thoughts. However, worry is different from obsession, because the worry in GAD is about real-­life or daily concerns, such as finances, work, and relationships. Worry in GAD is actually viewed as an attempt to avoid or distract a person from more-­upsetting and anxiety-­provoking thoughts and feelings

Post-­Traumatic Stress Disorder
Finally, post-­traumatic stress disorder (PTSD) is unique among the anxiety disorders, because it is the only one that requires people to have experienced some type of traumatic event before they can be diagnosed with it. PTSD is diagnosed when a person experiences a set of symptoms more than thirty days after exposure to a traumatic event. The symptoms of PTSD include intrusive thoughts and memories about the traumatic event (for example, flashbacks or feeling as if the event were happening all over again), avoidance of reminders of the traumatic event, difficulties experiencing positive emotions, feeling detached from others, and hyperarousal and hypervigilance (or always feeling on guard). If someone experiences these symptoms within one month after a traumatic event, we call the disorder acute stress disorder.

Sources: The Dialectical Behavior Therapy Skills Workbook for Anxiety

Sigmund Freud and Psychoanalysis

Born Sigismund Schlomo Freud in Freiberg, Moravia, Freud was openly his mother’s favorite child; she called him “Golden Siggie.” When Freud was four years old, the family moved to Vienna and Sigismund became Sigmund. Sigmund completed a medical degree and in 1886 he opened a medical practice specializing in neurology, and married Martha Bernays. Eventually, he developed the “talking cure” that was to become an entirely new psychological approach: psychoanalysis.

In 1908, Freud established the Psychoanalytic Society, which ensured the future of his school of thought. During World War II, the Nazis publicly burned his work, and Freud moved to London. He died by assisted suicide, after enduring mouth cancer.

Key works
1900 The Interpretation of Dreams
1904 The Psychopathology of Everyday Life
1905 Three Essays on the Theory of Sexuality
1930 Civilization and Its Discontents”

The Fight, Flight or Freeze Response

The fight or flight response has been around as long as human beings have been around. It’s the body’s hardwired alarm system. If you think of the human body as a computer, the fight-­or-­flight response is an essential part of the operating system. You couldn’t really function (or live that long) without it.

When you encounter a dangerous or threatening situation, this alarm system goes off, and your body goes through a number of changes. For example, during the fight-­or-­flight response, you may experience the following symptoms:

  • An increase in heart rate
  • Perspiration or sweating
  • Narrowing of field of vision (also called “tunnel vision”)
  • Muscle tension
  • Sensitive hearing
  • Racing thoughts
  • Shortness of breath
  • Goose bumps
  • Dry mouth

These experiences aren’t random; they all serve a very important purpose. They prepare you for immediate action. They are preparing you either to flee the situation to avoid any harm or to fight if escape is not possible. In situations where fleeing or fighting is not necessarily a good option, your body may also freeze (kind of like a deer caught in a car’s headlights).

This response is automatic. It occurs without thinking. This is important because it allows you to respond quickly when you are in a dangerous situation. For example, let’s say that you are walking through the woods and come across a bear. Your fight-­or-­flight response will be activated, and you will likely freeze or flee. The sudden and automatic changes that your body goes through will help keep you alive in this dangerous situation. Now, if you had to think about the situation before the fight-­or-­flight response was activated, you would waste precious time. You would have to evaluate the size of the bear and the sharpness of its claws and teeth. And, by the time you figured all of that out, you would probably be supper for the bear! Therefore, the fight-­or-­flight response is incredibly helpful and adaptive. We likely wouldn’t be alive as a species today without it.

Sources: The Dialectical Behavior Therapy Skills Workbook for Anxiety

What is Tardive dyskinesia?

Tardive dyskinesia (TD) is a neurologic disorder associated with the long-term use of certain medications (dopamine receptor-blocking agents) for some types of mental illnesses, such as major depressive disorder, bipolar disorder, and schizophrenia. TD causes involuntary movements of the body such as facial-tics, rapid eye blinking, sticking out of the tongue, lip pursing, and jaw clenching.

Some people experience involuntary twitching and jerking of their arms, legs, or torso. In this video, Lauren shares her personal experience with TD, and also sits down with Dr. Leslie Citrome, a psychiatrist and Clinical Professor of Psychiatry and Behavioural Sciences at New York Medical College, and who specializes in tardive dyskinesia.

Anxiety or Panic?

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?

Example 1:

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.

Example 2:

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.

Example 3:

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.

Example 1: A Normal Level of Anxiety

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.

Example 2: A Concerning Level of 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.

Example 3: Panic

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.

Sources: McLean Hospital

Dealing With Trauma Triggers

Most of us are aware of the larger trauma triggers. We can recognize some of the people, places, and things that harmed us, and do our best to avoid them all. For example, if our trauma had something to do with the beach we can avoid any area with sand or any sounds of the beach. We can sit down with our therapist and make a list of all of the things that we know trigger our trauma response or bring us back to those frightening events. But what about the unconscious triggers? The ones we don’t recognize, and often find upsetting us, pulling us into flashbacks and causing us to dissociate.

Schizoaffective Disorder: What are Hallucinations?

Hallucinations are a psychotic symptom of schizoaffective disorder. People experiencing hallucinations may hear, see, smell, taste or feel things that aren’t really there, and which other people can’t hear, see, smell, taste or feel.

Auditory hallucinations are the most common type of hallucination. They are mostly experienced as voices. To a person with schizoaffective disorder, these voices sound just like people speaking to them, and people with the illness cannot differentiate between what is real – for example a friend speaking to them – and what is a hallucination.

Voices might be heard in the second person – for example someone saying “you stink”, “you’re ugly”, “they hate you”. Sometimes voices might command a person to do something – by saying, for example, “jump off the bridge”, “take an overdose”. People with schizoaffective disorder may also have third person hallucinations, which commonly take the form of two or more voices talking among themselves or commenting on the person’s behaviour. Third person hallucinations are common in both schizoaffective disorder and schizophrenia, but are seen less frequently in bipolar disorder.

In most cases the experience of auditory hallucinations in the form of voices is unpleasant. Voices are frequently accusatory, reminding the person of past misdeeds, some imaginary, and some real. However, in a minority of cases, voices can be pleasant or even helpful.

In addition to voices, auditory hallucinations can involve noises, such as buzzing, screeching and ringing. Additionally, people with schizoaffective disorder may think that their own thoughts are being broadcast, or can be heard by other people. They may also think that other people’s thoughts are being forced into their own minds, or that their thoughts have been stolen from their heads.

Hallucinations of all five senses may be experienced. In addition to auditory hallucinations, people may have tactile hallucinations – such as feeling as though you are being pushed, touched or held down – visual hallucinations – such as seeing things that aren’t there or feeling that colours are brighter than they should be – hallucinations of smell and hallucinations of taste.

Visual hallucinations occur much less frequently than auditory hallucinations, and are more common in conjunction with auditory hallucinations – for example seeing and hearing someone who no one else can see. Hallucinations of smell and taste are more unusual and tend to focus on things tasting or smelling different than usual. This can lead to people with schizoaffective disorder thinking that their family and friends are trying to poison them.

Sources: Schizoaffective Disorder Simplified

Francis Galton and the Nature vs. Nurture Debate

Francis Galton counted many gifted individuals among his relatives, including the evolutionary biologist Charles Darwin. So it’s not surprising that Galton was interested in the extent to which abilities are either inborn or learned. He was the first person to identify “nature” and “nurture” as two separate influences whose effects could be measured and compared, maintaining that these two elements alone were responsible for determining personality. In 1869 he used his own family tree, as well as those of “judges, statesmen, commanders, scientists, literary men… diviners, oarsmen, and wrestlers,” to research inherited traits for his book Hereditary Genius. As predicted, he found more highly talented individuals in certain families than among the general population. However, he could not safely attribute this to nature alone, as there were also conferred benefits from growing up in a privileged home environment. Galton himself grew up in a wealthy household with access to unusually good educational resources.

Galton proposed a number of other studies, including the first large survey by questionnaire, which was sent out to members of the Royal Society to inquire about their interests and affiliations. Publishing his results in English Men of Science, he claimed that where nature and nurture are forced to compete, nature triumphs. External influences can make an impression, he says, but nothing can “efface the deeper marks of individual character.” However, he insists that both nature and nurture are essential in forming personality, since even the highest natural endowments may be “starved by defective nurture.” Intelligence, he says, is inherited, but must be fostered through education.

In 1875, Galton undertook a study of 159 pairs of twins. He found that they did not follow the “normal” distribution of similarity between siblings, in which they are moderately alike, but were always extremely similar or extremely dissimilar. What really surprised him was that the degree of similarity never changed over time. He had anticipated that a shared upbringing would lessen dissimilarity between twins as they grew up, but found that this was not the case. Nurture seemed to play no role at all.

The “nature—nurture debate” continues to this day. Some people have favored Galton’s theories, including his notion—now known as eugenics—that people could be “bred” like horses to promote certain characteristics. Others have preferred to believe that every baby is a tabula rasa, or “blank slate,” and we are all born equal. Most psychologists today recognize that nature and nurture are both crucially important in human development, and interact in complex ways.

Sources: The Psychology Book (DK)

Identify Your “Triggers”

Each person has specific types of situations that set their automatic negative path in motion; these are their triggers. To address your problems, you need to know which situations are difficult and trigger your negative path.

While many people are aware of their triggers, some have trouble identifying their specific trigger situations. For example, a person may tell you that they are “always” sad, or “always” drink too much, and can’t identify specific problematic situations. Identifying your triggers helps you start to see patterns and then know what to focus on in therapy.

A helpful first step is to monitor your problematic feelings or behaviors and see if there are some situations where your feelings are stronger or your behavior is more extreme. For example, a person came to therapy because they were always angry. When asked for examples of specific situations, they responded that they were angry “all the time.” The first homework assignment was to monitor their angry feelings and see when they were strongest. They came back having discovered that they were the most angry when their teenage son didn’t do what they wanted him to do; for example, when he did his homework at 2 a.m., broke curfew, or did not do his chores. They discovered that their anger toward her son was spilling over into the rest of her life.

Frequently, people will describe their trigger situation in vague terms, and don’t really understand what happened. They need to become more specific and concrete. A specific and concrete description includes what happened, with whom, and the specific time and place it occurred. For example, a vague description of a situation would be “My partner doesn’t respect my work”; a more concrete and specific description would be “My partner told me that they thought their work was more important than mine.”

The more specific and concrete your description of the situation, the more you will be emotionally engaged with the situation, and the more you will have access to your feelings and thoughts. Think of someone you are a little annoyed with. Now, think of a specific situation when you were annoyed with this person. Try to remember the situation in detail. Chances are that as you thought about a specific situation, you became more annoyed and your feelings and thoughts became more immediate.

Sometimes your situation is a long, complicated story. In this case, consider the whole story and then ask what was the worst or most difficult part for you. It is helpful to identify a situation that lasts from a few seconds to three minutes, any longer and you will probably have a large variety of feelings and thoughts, and it will be hard to focus on the main ones.

Sources: CBT Made Simple

A Structured Cognitive Behavioral Therapy (CBT) Session

A structured session means that there is an order and organization to the therapy session. Here is a brief overview of the five basic components.

Check in. This is a quick update on what has happened since the previous session and includes a bridge to that session.

Set the agenda. You and your therapist decide together which problems to focus on in the current session. Homework from the previous session can be reviewed during the check-in or as part of the agenda-setting process.

Work the agenda. This involves addressing the identified problems on the agenda.

Homework. You and your therapist collaborate to develop homework for the following session.

Review. At the end of the session you briefly review with your therapist what was covered in the current session and give feedback.

Sources: CBT Made Simple