Treatment for Anxiety, Worry, Perfectionism, & Panic

Generalized Anxiety Disorder is characterized by persistent and excessive feelings of anxiety out of proportion to what is reasonable, or when there's no apparent reason for concern. It often includes and is perpetuated by repetitive worry or rumination and interferes with daily activities, relationships, and overall health and well-being.

Perfectionism is a common trait and way of being that tracks closely with anxiety disorders. It gets in the way when “good enough” is no longer an option at our own expense, suffering, time, and when it prevents us from being flexible.

Social Anxiety Disorder is characterized by fears of being evaluated negatively, about what others think, about not being able to connect, and about being awkward or bad at social interactions. It often leads to excessive comparing yourself to others and avoidance of various social situations.

Performance Anxiety involves fears of making a mistake, being embarrassed, or being evaluated poorly, and avoidance of performance situations, presentations, large groups, or public speaking is common.

Panic Disorder occurs with the presence of repeated panic attacks and increasingly just the fear of having another panic attack. Panic attacks are discrete periods of intense fear or discomfort during which time a person can experience several of the following symptoms: trembling or shaking, shortness of breath, sensations of choking, chest pain, increased heart rate, nausea or abdominal pain, dizziness or feeling faint, fear of losing control or dying, numbness/tingling sensation, feelings of being detached from reality or oneself.

The hallmark of panic disorder is a fear of the next panic attack and avoidance of people, places, or situations where a panic attack could be triggered.

COMMON PRESENTATION OF ANXIETY

While each person's experience with anxiety may differ, there are some common presentations to be aware of:

• Constant Worry: You may find yourself consumed by worries about everyday situations, future events, and potential worst-case scenarios.

• Physical Symptoms: Anxiety often manifests as physical symptoms such as restlessness, muscle tension, fatigue, headaches, gastrointestinal issues, and difficulty sleeping.

• Difficulty Concentrating: Due to excessive worry, it becomes challenging to concentrate on tasks, leading to decreased productivity and increased frustration.

• Irritability: Anxiety can make you feel irritable or on edge, causing you to react more strongly to minor stressors or trigger situations.

• Avoidance: Some individuals may start to avoid situations or activities that trigger anxiety, which can limit their life experiences and overall quality of life.

• Perfectionism and Need for Control: the false idea that if we can manage everything down to the letter then we can eliminate risk or uncertainty. While this sometimes appears helpful, it usually comes with significant costs.

COMMON APPROACHES TO ANXIETY THERAPY

Effective treatments are available to help you manage and alleviate generalized anxiety and worry. Here are some commonly used approaches:

• Anxiety Therapy: Behavioral therapies such as Cognitive-Behavioral Therapy (CBT), Acceptance-Commitment Therapy (ACT), Mindfulness Based Cognitive Therapy (MBCT) and Exposure-Response Prevention (ERP) can be highly effective in treating anxiety conditions. These approaches focus on identifying and challenging negative thought patterns, managing uncertainty, developing coping strategies, teaching relaxation techniques, and being more intentional about how you focus your attention and which thoughts you choose to engage with or not. In other cases, it may make sense to focus on your interpersonal relationship patterns or address past trauma with strategies such as psychodynamic therapy or Eye Movement Desensitization and Reprocessing (EMDR) therapy.

• Pharmacotherapy for Anxiety: In some cases, medications such as selective serotonin reuptake inhibitors (SSRIs), as well as other types, may help to alleviate the severity of symptoms, create more distance from unhelpful thoughts, and improve your management of anxious states.

  Even if you have tried anxiety medication in the past, a new consultation can be worth your time. In my experience, psychiatrists less specialized in anxiety don’t always appreciate how somatically sensitive patients with anxiety can be, often too quickly using doses that are too high. In many cases, taking care to allow your system to adjust slowly can make a big difference in tolerability and efficacy. Additionally, there are several newer agents available now, as well as different classes of medications such as beta-blockers, alpha2-agonists, and gaba agents that might be helpful.

• Lifestyle Modifications: Adopting healthy lifestyle habits including regular exercise, balanced nutrition, sufficient sleep, intentional time in nature, social connection, and various stress management techniques can significantly reduce anxiety levels. We can review all of these areas in our consultation to personalize treatment to your specific circumstances and life.