Treatment for Excessive Worry

Treatment for Excessive Worry

Dr. Neal Ranen, M.D. Offers Anxiety Treatment in Baltimore

Fear serves as a filter that assists in the recognition of danger. It heightens the reflexes and increases mental alertness. The fear response was particularly important in the early days of humankind when there was a need to be vigilant for mortal threats, such as suddenly encountering a mountain lion. However, our anxiety system is not as well-adapted to the stressors of modern life. Although some degree of worry can be helpful (like not being too blasé about work deadlines) when fears present themselves constantly and evolve into unescapable alarm or a lingering worry, they can have a negative impact on everyday life. This is a sign or indication that one may be dealing with a form of anxiety or an anxiety disorder. Almost 30 million Americans suffer from disorders such as this, and more than 10 percent of the population experience severe symptoms of anxiety that are in one way or another connected to physical ailments. Anxiety is believed to an underlying factor in at least 20 percent of existing medical conditions in people who seek primary health care.

Anxiety manifests in a variety of different ways. For example, phobic disorders are out of the ordinary, horrific fears about a certain thing or object, places or social circumstances. Psychiatrists classify phobic disorders into different groups, such as social, specific or agoraphobia.

Social phobias are fears of an irrational nature that cause the person to avoid being in a particular situation where others may watch or notice them. This can include performance anxiety or phobia, but the social phobia terminology describes signs that exceed simple nervousness prior to a performance in front of a group or crowd of people. People who combat this form of anxiety have a strong fear of people watching, and often judging them, when they are doing certain things. These can be simple things such as having a conversation with someone, checking out at the grocery store, ordering a coffee at Starbucks, eating in a restaurant or attending a fitness class. Social phobia can reach a point that makes it almost challenging for people to attend school, go to work or interact socially with others at all. These phobias occur with both women and men, typically occur after puberty and typically hit their peak after they turn 30 years of age.

Specific phobias are quite common. This particular disorder is reflective of its name, in that it is a fear that people may have of a specific object or situation. If the object of fear is something typical, the results can be devastating. This category generally involves a fear of animals such as snakes, cats, dogs or insects. Then there is a fear that some may have of being in closed spaces, also referred to as claustrophobia or a fear of heights, acrophobia. These phobias generally arise during the younger years and may at some point go away. However, if the phobia carries into adulthood, it tends to persist without treatment.

Agoraphobia literally translates into a fear of the marketplace. It is a fear and avoidance of public or crowded spaces or places from where the person feels they cannot easily exit or escape. It can be related to a fear of having severe anxiety or a panic attack outside of one’s safe zone, typically the home. This phobia occurs in women more than men and is the most impairing of the group. Those suffering from this phobia have a fear of being stuck or alone in a place from which they feel will be difficult to escape. They simply believe that there would be no help if they became entrapped or have a panic attack in a space or area. Of course, ironically, a person would be much better off falling ill around a group of people than alone at home. Misplaced fear of embarrassment over becoming ill or having an anxiety attack around others can be part of this. This group of people tries their best to avoid places with crowds such as sporting events, churches, movie theaters and other similar spaces. This causes them to miss out on several events or social engagements. They withdraw from social activities by avoiding them completely. It causes such a fear in them that they literally become a prisoner in their own home. If circumstances lead them into places they fear, they can be completely overwhelmed with distress. Rarely will they enter this type of environment alone and, rather, they are in the company of a friend or a family member.

Psychotherapy and medication are appropriate and effective treatments for excessive worry and phobias. Psychiatrists utilize special techniques that have been researched and proven to help those suffering from phobic conditions. These include forms of Cognitive-Behavioral therapy and Exposure/Response Prevention. Many patients undergo desensitization treatment with great results. Techniques such as deep muscle relaxation help those with phobias to detect and relieve anxiety. This is followed by mental relaxation. Relaxation shifts the nervous system from a baseline of hyper-arousal to a relaxed resting mode. Then, the person learns to overcome their fears through progressive exposure in imagination and then in real life. This is done gently to achieve a relaxed, non-anxious state at every stage. After several treatments, the circumstance or object that caused the fear to generate eventually diminishes and no longer provokes fear in the person. Eventually, people can learn to put themselves into a relaxation state at their will, even when out and about, or when faced with a stress or trigger. Interestingly, the Biathlon in the Winter Olympics is a great example of the power of relaxation training. These athletes spend a lot of time doing relaxation exercises to help slow their heart-rate when they transition from the cross-country skiing portion to target shooting. The slower heart rate allows for more accuracy by reducing the bobbing of the rifle scope.

Tendencies towards automatic negative thoughts and the beliefs that underlie them can also be explored.

As above, the combination of psychotherapy and medication (particularly non-habit-forming, non-addictive medication) can be highly effective. There are several medications that are proven treatments, and specifically FDA-approved, for Anxiety Disorders, including phobias. So, the judicious use of medication can be extremely helpful.

There are a variety of theories as to why phobias occur in people. Some studies support that there may be imbalances in the chemistry of the brain, while others propose that phobias may be the result of negative messages or a traumatic event from childhood that has been buried emotionally and mentally. Genetic factors have been demonstrated, and, as such, anxiety often runs in families. An individual’s disposition may also play a role. For example, many people are much more concerned with avoiding bad things happening or making mistakes, rather than being influenced by positive experiences or successes. Stress in life or a significant loss can lead to certain phobias also. It is imperative to seek medical attention when phobias occur and lead to excessive anxiety.

When seeing individuals, I sort all this out and design the optimal treatment approach — one that is best for them. Contact me, Dr. Neal Ranen, M.D. to set up an appointment for an evaluation.

This article was originally posted on drnealranenbaltimorepsychiatrist.com 2/28/2018

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Holidays Cause Social Anxiety to Surface

Holidays Cause Social Anxiety to Surface

Dealing With Anxiety During the Holidays

The holiday season is accompanied by many emotions and expectations. Gifting, family gatherings, office parties, school programs, social events and more are at an all-time high during this time of year. It is quite common for social butterflies to surface and make a grand attempt to attend almost every festivity. This is not the case for those who live with social anxiety. While some may encourage sufferers of the disorder to simply get over it, those who experience it understand that it is not an easy thing to do.

When does Perfection become Unbearable?

Adaptive perfection has been defined as striving for reasonable and realistic standards. Socially this would mean that one follows the rules of conduct and adapts to different social situations in a flexible manner without being too concerned about minor slip-ups.

In nonadaptive perfection, there is a tendency to strive for excessively high standards which is motivated by fear of failure. Socially this would mean that rules of conduct are applied in a very rigid manner which is driven by fear of being judged. As a result, social interactions become very stressful. Higher the distress the greater the indication that nonadaptive perfection is playing a role.

The Costs of Nonadaptive Perfection

Imagine facing the stress of going on a first date, especially during the holidays, and also having to ensure that you meet very high standards to ensure that nothing about you could be judged whether it is your weight, appearance, grooming, quality of your conversation, etc. Trying to be perfect in this manner is exhausting and can make one feel tense and anxious.

When one is trying to be perfect, the tendency to be hypervigilant of one’s errors increases. The focus on one’s imperfections can cause them to seem much worse than they really are. It will not allow one to get absorbed in or enjoy conversations.

The process of self-monitoring to ensure high standards results in conversations that lack spontaneity. People who experience social anxiety are usually trapped in a situation where they want to have closer connections but all that they do to make sure it happens tends to actually prevent it from happening. Their need for perfection inhibits them from being themselves which hinders authentic connections that lead to belonging and acceptance.

What people with Social Anxiety are often not too cognizant of is the fact that everyone has deficiencies. They do not really see others as flawed and human as they are. They make unfair comparisons and their thinking is often distorted.

The Adjustment from Nonadaptive to Adaptive

It is clear that nonadaptive perfection has several costs. Reducing high standards of perfection can be scary but if done in gradual stages the costs of the unhealthy perfection will diminish and you will gain the freedom to be yourself.

Seeking the help of a professional like Dr. Neal Ranen, M.D. in Baltimore County would be good, since you will have an ally and an expert in your corner who will guide and cheer you on.

Acknowledge your imperfections and make them uniquely perfect for you!

Originally posted on drnealranenbaltimorepsychiatrist.com