Anxiety Counseling
Anxiety can mean nervousness, worry, or self-doubt. Sometimes, the cause of anxiety is easy to spot, while other times it may not be. Everyone feels some level of anxiety once in a while. But overwhelming, recurring, or “out of nowhere” dread can deeply impact people. When anxiety interferes like this, talking to a therapist can help.
The Internal Battle Against Intense Fear
“I couldn’t breathe!”
“I felt like I was having a heart attack!”
“I thought I was dying!”
-People usually describe themselves in this way when they are having a panic attack-.
Note. Source: (Lynn, 2019)
"I feel like I am choking. I feel an urgent need to leave the area as soon as possible or something
bad will happen". - Diane
How to define Panic Attack?
A panic attack is sudden episodes of intense anxiety and fear that induces a combination of physical and psychological symptoms. Panic attacks can be frightening because they occur abruptly even when you are relaxed or asleep. They usually reach their peak in 5 to 10 minutes and persist for about half an hour. Panic onset could happen as early as the age of 12. Many people experience a panic attack once or twice in their lifetimes but frequent and repeated panic attacks might be a precursor of panic or anxiety disorder.
Sometimes people can experience increasing anxiety by just thinking of having another panic attack (i.e. anticipatory anxiety). If panic attacks remain untreated, one’s life may get impacted in a significant way. People may actively avoid places where one has previously happened or cease activities that may trigger the following attacks such as riding an elevator, using public transportation, or skipping social events, resulting in the development of agoraphobia (i.e. fear of going into public spaces or crowds).
What should I know about the symptoms of panic attack?
Panic attacks are associated with palpitations, shortness of breath, trembling, nausea, dizziness, numbness, feelings of choking, fear of losing control, and fears of dying. In addition to the typical fight-or-flight responses and extreme fears, people may experience depersonalization, which is the feeling of detachment from oneself. One may also experience derealization, perceiving the external world as dreamy or unreal.
Panic attacks are often accompanied with abnormal chest pain and rapid heartbeat that resemble the feeling of having a real heart attack. As a result, people who are experiencing their first panic attack typically ended in the emergency room (ER).
There are two common types of panic attacks. An expected panic attack occurs when responding to panic triggers or specific cues. For example, one who has a fear of blood (hemophobia) may expect to have panic attacks when seeing blood or getting blood tests. Conversely, an unexpected panic attack happens without any apparent triggers.
What are the causes of panic attack?
The causes of panic attacks are unclear. Several factors which are usually involved, including genetic predisposition, major life transitions, and extreme stress. For example, graduating from a university, starting a new job, childhood trauma or losing a loved one could potentially trigger panic attacks. Panic attacks are differentially reported among genders. More severe panic attack symptoms and agoraphobia avoidance are usually found in women.
How can panic attacks be treated?
Early treatment can be effective to reduce the symptoms and the risk of recurrent attacks. Cognitive behavioural therapy (CBT) helps people to identify their symptoms, alter their thinking pattern and behaviours in response to the situations that trigger fears to a more realistic level. CBT allows them to be exposed to fear-provoking situations or experience the physical sensation of the attacks by using imagery, bodily focusing and voluntary hyperventilation. With each exposure, you will be less afraid and gain back control over the panic. Training in deep breathing and progressive muscle relaxation techniques also allows people to calm themselves down after symptoms onset. Trivial things such as avoiding caffeine, exercising regularly (e.g. yoga) and getting sufficient good quality sleep may help release stress and anxiety. Besides, antidepressants (e.g. selective serotonin reuptake inhibitors, SSRIs) and anti-anxiety medications (e.g. benzodiazepines) can be used to control some of the symptoms temporarily. However, benzodiazepines may bring some unwanted side-effects.
References
American Psychiatric Association. (2013). Diagnostic and statistical manual of mental disorders (DSM-5®). American Psychiatric Pub.
Emamzadeh, A. (2018). Panic Attacks: Nature, Types, and Symptoms. Retrieved 1 July 2020, from https://www.psychologytoday.com/us/blog/finding-new-home/201808/panic-attacks-nature-types-and-symptoms
Huffman, J. C., Pollack, M. H. (2003). Predicting panic disorder among patients with chest pain: An analysis of the literature. Psychosomatics, 44, 222–236.
Lynn, C. (2019, September 1). Anxiety is a spirit guide; Or how I deal with panic attacks. Crystal Lynn Bell. https://www.crystallynnbell.com/anxiety-is-a-spirit-guide-or-how-i-deal-with-panic-attacks/
Goodwin, R. D., Lieb, R., Hoefler, M., Pfister, H., Bittner, A., Beesdo, K., & Wittchen, H. U. (2004). Panic attack as a risk factor for severe psychopathology. American Journal of Psychiatry, 161(12), 2207-2214.
Salkovskis, P. M., Clark, D. M., & Hackmann, A. (1991). Treatment of panic attacks using cognitive therapy without exposure or breathing retraining. Behaviour Research and Therapy, 29(2), 161-166.
Sheikh, J. I., Leskin, G. A., & Klein, D. F. (2002). Gender differences in panic disorder: findings from the National Comorbidity Survey. American Journal of Psychiatry, 159(1), 55-58.
Wittchen, H. U., Nocon, A., Beesdo, K., Pine, D. S., Höfler, M., Lieb, R., & Gloster, A. T. (2008). Agoraphobia and panic. Psychotherapy and Psychosomatics, 77(3), 147-157.
Generalized Anxiety Disorder (GAD)
When Anxiety “Robs” Your SERENITY
Source: Shutterstock
What is GAD?
Anxiety is part of our daily life. It is normal to feel anxious about something or about certain events, as it could be warning us of a potentially dangerous situation, helping us to plan ahead for it. However, when the anxiety becomes excessive, chronic, uncontrollable then it might be a disorder. Generalized Anxiety Disorder (GAD) is defined as having excessive and pervasive worry on everyday life events, or even something that does not exist. They would be worrying so much that it interferes with their daily functioning, and their relationship with others because they couldn’t control the worry. Symptoms usually first appear during adulthood, but it does occur in all ages too including childhood and adolescence. Interestingly, what differs between having GAD during childhood/adolescence or during adulthood is the content of their worry, which tends to be age-appropriate. Children and adolescents would tend to worry about their competency at school, sports performance, possibility of catastrophic event, etc; while the adults would tend to worry about their work performance, their family well-being, their physical health, etc. The common symptoms of an individual with GAD are as stated below:
– Difficulty concentrating
– Trouble sleeping
– Irritability
– Easily fatigue
– Muscle tension
– Restlessness, or feeling on-edge
What causes GAD?
There are no specific factors that contribute to the development of GAD, however, we are able to identify a few common factors that influence the development of GAD. Firstly would be the genetic predisposition. Studies have shown that if one of our first degree relatives, such as parents, siblings, and your child, have GAD we would have a higher risk of developing one too. Surprisingly, women are also more likely to have an anxiety disorder in general than men. Secondly, our life experiences would also play a big role in developing GAD in us. Researchers have found that experiencing trauma in childhood could increase our risk of developing GAD. Traumatic experiences such as the death of a loved one, involved in a major car accident, abandonment, physical and mental abuse, neglect, etc. These traumatic events would leave us feeling uncertain, feeling extra cautious, or humiliated, it is understandable that it would make us more anxious in different circumstances later on in life.
Treatment for GAD?
Similar to most mental disorders, psychotherapy and medication are the most common treatments for GAD. Cognitive-Behavior Therapy (CBT) is one of the most common and effective therapy for GAD, as its benefits could last longer than having medications, not to mention that some medications could have side effects. CBT aims to modify your thinking and behaviors, to be mindful of your thinking process and to help you to distance yourself from those anxious thoughts. However, there is no single treatment that works for everyone. Some may prefer or actually require medication instead of CBT.
Medications such as anti-anxiety, anti-depressant, or sedatives are usually prescribed. Anti-anxiety, such as Xanax and Klonopin, have high risk of dependency and abuse; Antidepressant such as Buspar, Zoloft, Lexapro, etc, might have several side effects including dry mouth, nausea, diarrhea, dizziness, headaches, etc; sedative such as diazepam are usually prescribed for severe cases as it helps to ease severe anxious symptoms within 30 to 60 minutes.
There are also less formal approaches in easing the symptoms, by changing their daily lifestyle. These may include regular exercise, yoga/meditation, a well-balanced diet, good quality of sleep, and self-help books.
Living with GAD
Living with GAD is not easy, for both the person and the relatives/caregivers. It makes their lives frustrating and terrifying, as the patient would be worried about anything and everything most of the time. For example, laying awake at night worrying that your house would get burned down, you have forgotten to do your homework and worry that it might end your school career, when your husband/wife ran up to a grocery store and you worried that a drunk driver would drive over and kill him/her. Especially at night before bed, you may find your thoughts running through your worries, giving you a hard time to fall asleep. These are the parts of the daily life of someone that has GAD.
However, if you are a victim of GAD, remember while you walk through your journey with GAD, you are not alone and you could still live a fulfilling and normal life. You might feel it’s hard and uncontrollable right now, but there are resources, trained professionals, and coping techniques to help you with it. Learning how to manage your triggers and keep a positive attitude will all help.
References
Wittchen, H.-U. (2002). Generalized anxiety disorder: prevalence, burden, and cost to society. Depression and Anxiety, 16(4), 162–171. https://doi.org/10.1002/da.10065
Gottschalk, M. G., & Domschke, K. (2017). Genetics of generalized anxiety disorder and related traits. Dialogues in clinical neuroscience, 19(2), 159–168. Retrieved from https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5573560/
Borza L. (2017). Cognitive-behavioral therapy for generalized anxiety. Dialogues in clinical neuroscience, 19(2), 203–208. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5573564/
Glasofer, D. R. (2020, July 11). An Overview of Generalized Anxiety Disorder. Verywell Mind. https://www.verywellmind.com/generalized-anxiety-disorder-4157247
Carey, E. (2020, April 3). Generalized Anxiety Disorder. Healthline. https://www.healthline.com/health/anxiety/generalized-anxiety-disorder
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