While anxiety is a normal response designed to protect us from harm by responding to dangers with the fight or flight response, excessive anxiety can significantly impact our lives and cause distress. Usually, anxiety consists of worries, body sensations (racing heart, difficulty breathing, sweating), and avoidance behaviors. Together these create a cycle that increases anxiety over time.
Although it is natural to escape from scary situations, avoidance of safe but anxiety-provoking situations increases anxiety in the long run.
Individuals with many different worries that are hard to control may have Generalized Anxiety Disorder. Worries may revolve around safety, school, work, friendships, family, health, world events, weather, performance, the future, new situations, or anything at all. “What if…” and catastrophizing worries about worst-case scenarios may be common. These worries may lead to physical complaints, such as headaches, stomachaches, fatigue, restlessness, or difficulty falling or staying asleep. They may also lead to reassurance-seeking (repeatedly asking the same questions) or avoidance of anxiety-provoking situations.
Social Anxiety manifests as excessive worries in social situations. Individuals may worry about being judged or doing something embarrassing. When social situations are too stressful, they are often avoided, which can affect relationships, school, and work.
Children who worry about being alone or away from their parents may have separation anxiety disorder. They may worry that something bad may happen to them or their parents when separated, and try to avoid being away from their parents. These children often have a hard time going to school, sleepovers, playdates, or sleeping independently, and have increased anxiety prior to separating in these situations. They may ask for repeated reassurance if they or their parents will be ok, or repeatedly call or text their parents when separated.
Panic Disorder is characterized by recurrent and unexpected panic attacks that seem to arise out of the blue. These panic attacks consist of sudden intense physical sensations (sweating, racing heart, shortness of breath, chest pain, dizziness, nausea), fear of losing control, having a heart attack, or dying that peak within minutes. They may fear these sensations and avoid situations that may trigger a panic attack.
Some children or adults may fear specific things (e.g., dogs, snakes, insects, earthquakes, heights, storms, needles, airplanes, elevators, loud noises, costumed characters, vomit). They often worry about these fears and try hard to avoid them.
Individuals with excessive worries about somatic symptoms (or body sensations, such as pain) that cause significant anxiety and interference may have Somatic Symptom Disorder. They may also have a lot of worries about their health and seek reassurance from multiple healthcare providers. The somatic symptoms may or may not have a medical explanation, but either way the suffering is real.
Conversion disorder is defined as a change in motor (e.g., weakness, paralysis) or sensory (e.g., loss of consciousness that may appear to be like an epileptic seizure) functioning that cannot be explained solely by a neurological or medical condition. Conversion symptoms may be triggered by stress or trauma, including medical trauma.
Cognitive Behavioral Therapy (CBT) is an effective treatment for anxious children, teens, and adults. CBT targets anxious body sensations (by teaching relaxation skills), worries (by changing the way we think and developing coping thoughts), and behaviors (by slowly approaching instead of avoiding scary situations). As we have the most control over our behaviors, it is the most important component of CBT. By slowly approaching (instead of avoiding) feared situations through exposure therapy, we then learn to manage anxiety.
Exposure therapy involves gradually facing fears in a safe environment until you get used to them, anxiety decreases, and you learn new information about yourself. Patients often learn that they enjoy experiences (e.g., public speaking, making new friends) that they previously feared, or that they are stronger and braver than they expected. I work collaboratively to design individualized exposures to target each fear, and exposures are conquered one at a time according to your goals and values. Exposures are also balanced with compassion in a safe environment, so that you feel supported while working towards managing anxiety.