Anxiety: What’s Normal and What’s Not?

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Angela is a forty-eight year old woman who entered therapy due to her anxiety related to driving a car. The anxiety became so severe that for two months, her husband had to drive with her to and from work each day to avoid a possible panic attack behind the wheel. Since he worked in the opposite direction, this was highly inconvenient and began to create stress in their marriage. It was this stress that compelled Angela to seek treatment.

Angela entered therapy highly motivated to fix her problem with anxiety. In treatment, she revealed that driving was not the only time she experienced high anxiety. These feelings were present during other times in her life. She often felt anxious at work and at home “for no apparent reason” when randomly with family, friends, or alone. The anxiety would strike during different times of the day and did not seem to be connected with a particular situation or triggering event. In other words, there was no pattern that she could determine as an underlying cause of her distress.

Angela did have a past history of anxiety, although the symptoms were not nearly as severe. She vividly recalled that in both high school and college she felt “flashes of anxiety,” but stated that the feelings would pass rather quickly and never caused her dysfunction. There was only one time in her life that she remembered her anxiety being so severe that she became immobilized. In her second year of law school, Angela was chosen to argue a case in front of a guest speaker. She had done this on other occasions with no problem, but on this occasion, she was hit so hard with anxiety that she could not even get out of bed.

Most people will experience a certain level of anxiety in their lifetime. Anxiety is an unpleasant emotional state that includes fear, apprehension, and worry. In its milder forms, it can be a motivator for action, an indicator for change in the person’s life, or a sign of stress or impending danger. It is temporary and the person returns to their normal level of functioning and emotional comfort quickly.

When anxiety symptoms are more severe however, they are chronic and highly overwelming to the person experiencing them. So much so, that this type of anxiety can immobilize a person and interfere with their daily funcioning, as in Angela’s case. Physical symptoms such as heart palpitations, nausea, dizziness, chest pain, shortness of breath, and profuse sweating often accompany the feelings of anxiety. These symptoms, among others, indicate that the person is experiencing a panic attack. Panic attacks come on suddenly and usually last less than ten minutes. However, they are so intense and frightening that most people who experience them believe they are going to die. Panic attacks are commonly mistaken for heart attacks since the symptoms are highly similar and can overlap. Panic attacks cause the person to feel highly vulnerable and very much out of control leading to even greater distress and often more panic attacks.

Millions of Americans suffer from anxiety disorders each year. An estimated forty million adults (age eighteen and older) are affected in the U.S. alone making anxiety disorders the most common mental illness in America. Fortunately, anxiety disorders are treatable and the vast majority of people inflicted can successfully diminish their discomfort with the help of the right professional care.

Research illustrates that psychotherapy (in particular cognitive-behavioral therapy) either alone or in combination with psychopharmacology (medication) is the most effective treatment for anxiety. Since every person is different, there are no guarantees for success; however, outcome studies prove highly hopeful.

I highly encourage any person who is struggling with anxiety to seek professional help. Unfortunately, many people suffering do not. When speaking with these patients about their reasons for not seeking help, the most common response has been “I thought the feeling would pass” or “I thought I could deal with it on my own.” This makes sense since anxiety is usually first experienced in childhood and normalized by parents, teachers, and friends and therefore, does not seem out of the ordinary.

Interestingly, it is usually not until the condition worsens and causes dysfunction that the person takes stock in how bad things have become. Many people have said to me “I didn’t realize how much anxiety affected my life until it got really bad.” “Really bad” could mean losing a job, failing a class, or the inability to drive a car. It is different for everyone. In any case, recognizing that things have gotten “really bad” often occurs later in life when the person is able to compare their level of anxiety with others.

Angela stated that she talked with friends who said they have experienced bouts of anxiety in their lives, but nothing to the extent where they were unable to get themselves out of bed or drive themselves to work. At first, Angela was surprised. She assumed other people had similar bouts with anxiety and strangely thought it was normal to some extent. Looking back, she could logically see that it was not and was glad she finally sought out treatment.

Patients often come into my office thinking that their experience with anxiety is “normal.” In fact, when asked about anxiety, many answer that it is minimal even when observably it is not. Like Angela, they are surprised to find out that others do not share their level of anxiety. These individuals have gotten used to feeling this way even though it is not something they like or desire. In turn, they develop coping mechanisms to deal with their distress. Some of these coping mechanisms may be positive and some negative. If the coping mechanisms are negative, this may be seen as the problem rather than the anxiety. This is particularly important to explore with a professional so that the right problem is being treated.

For example, Angela revealed that one of her coping mechanisms is drinking. She does not believe she has a problem with drinking, but does admit that she uses it often as a way to deal with her anxiety. This coping mechanism developed in college and is still present. If she has a very stressful day or she is anxious in a certain situation, she likes to relax with a glass of wine. This immediately calms her down. One of the reasons Angela may not have realized her level of high anxiety is because she was self-medicating. Perhaps without this coping mechanism she would have sought treatment for her anxiety disorder earlier in her life.

If she developed a problem with alcohol, an unknowing therapist would treat her alcohol problem without treating her anxiety at the same time. Obviously, an alcohol problem would require alcohol treatment, but without the treatment of anxiety, which caused the alcohol abuse in the first place, the distress would remain. Alcohol abuse is just one example; however, there are many others such as self-injury, eating disorders, clinical depression, etc. A full assessment in these cases is always a good idea to get to the bottom of what the problem is and then to treat it properly. Most importantly, remember that there is hope and treatment is available.




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