Welcome back to our second episode, where we will be talking about all things ANXIETY! We discuss about what anxiety is, the disorders that fall under the umbrella of anxiety, common symptoms, diagnosis , treatment and our personal ways to relieve anxiety. Have you ever experienced anxiety? US TOO! If you haven't listened yet... STOP what you're doing and go hear the episode. Come back here after for these show notes and product links.
What is Anxiety?
Persistent, excessive fear or worry in situations that are not threatening causing functional impairment
Most common childhood onset psychiatric disorder
Diagnosed commonly in children and adolescence but can also be diagnosed in adults. Earlier diagnosis is associated with an increased risk for developing depression, substance abuse, and suicidal ideation. Course of anxiety disorders is variable.
Co-occurring and associated conditions: Major Depressive Disorder, ADHD, Substance Use, Eating Disorders, Oppositional Defiant Disorder, Language Disorders, Learning Disabilities
Prevalence: 10-30%! 40 million people in the US experience an anxiety disorder in any given year! 1 out of 13 globally suffer from anxiety. These numbers are outstanding, so we need to pay attention.
Anxiety Disorder Subtypes based on the DSM-V criteria:
- Generalized Anxiety Disorder (most common): More common in women then men, onset usually in school age children. These people experience chronic anxiety, exaggerated worry and tension about everyday life
- Social Anxiety/Social Phobia: Most common in early adolescence. Overwhelming anxiety and excessive self-consciousness in everyday social situations. Varies in severity such as, can be limited to a specific situation versus occurring at all times of the day in all situations whether formal or informal.
- Panic Disorder: usually occurs in late adolescence. Unexpected and repeated episodes of intense fear accompanied by physical symptoms like chest pain, palpitations, shortness of breath, dizziness or upset stomach.
Panic attacks (single episode) vs Panic Disorder (multiple panic attacks)
Feelings of impending doom
- Agoraphobia: Pronounced fear in certain environments and situations. For example, when in crowded places, using public transportation or even just being outside of the house and alone causes fear that something will happen. People with agoraphobia have thoughts of being unable to escape or cope with the physical symptoms
- Specific Phobia: onset usually around 7 years old. Specific to a certain situation (person or place). Intense enough to affect daily life. Fear of acting in a humiliating or embarrassing way.
Subtype: Performance Anxiety - such as, anxiety before public speaking (the only form of anxiety that can be treated with a beta blocker)
- Separation Anxiety Disorder: Onset around 7 years old as well. Commonly seen in children when they cannot be separated from their parents. Excessive worry that something bad will happen when they are separated from their parents.
- Selective Mutism (Rare): Usually develops between ages 2 and 4. A child will refuse or be reluctant to speak in certain settings. For example, the child will talk at home and with certain family members or friends but does not speak in school or other settings
- Substance/Medication Induced: Involves intoxication or withdrawal from medication or drugs
Side Note:
OCD: recurrent unwanted thoughts (obsessions) and/or repetitive behaviors (compulsions). Perform rituals for temporary relief.
Acute Stress Disorder and PTSD: ASD presents within a month of event, PTSD presents after one month. Occurs after exposure to a terrifying event in which you had direct physical harm or observed harm. Commonly seen among people who have been sexually assaulted, those who lived through a natural disaster, and in those who have been in military combat. People may experience recurrent flashbacks or nightmares and they try to avoid these situations leading daily functional impairment.
Signs and Symptoms
Signs: Social refusal behavior, avoidance, excessive need for reassurance, poor school performance, explosiveness, binge eating or not eating at all, suicidal thoughts, among others.
Physical/Somatic symptoms: palpitations, headaches, chest pain, dramatized pain, shortness of breath, fatigue, dizziness, lightheadedness, insomnia, upset stomach, etc.
Causes: Genetic (increased risk in families who have this diagnosis) and Environmental (i.e.: experiencing a traumatic event)
Diagnosis
Symptoms must be present for at least 6 months
Perform a complete evaluation (i.e.: assess medical conditions such as, cardiac and thyroid issues)
Confirm that there is no physical illness causing this
Be evaluated by a physician and a mental health professional
Assess for co-occurring conditions
Treatment
Note: a combination of therapy and medication is more effective then either treatment modality alone
Psychotherapy: identify inappropriate thinking patterns. A type of psychotherapy known as, Cognitive Behavioral Therapy works to assess your reaction to events and then utilize strategies to reduce the beliefs as well as, behaviors that lead to the symptoms.
Another subtype known as, exposure-response prevention, is used for specific anxiety disorders to develop a more constructive response to a fear by exposing yourself to what you fear in order to decrease the anxiety overtime and develop appropriate coping mechanisms.
Medications:
Benzodiazepines (i.e.: Xanax, Ativan): can be used for short term symptom reduction, sometimes given in the acute setting while the SSRIs take effect. These drugs are commonly misused and you can become dependent on them so you want to avoid these medications when possible.
SSRIs (antidepressants like Paroxetine, Cymbalta) are first-line and is also beneficial in those with co-occurring depression.
3. Self-Management strategies: allow for specific times in the day dedicated to "worrying"
4. Stress and Relaxation techniques: deep breathing exercises, focused attention to calming the mind and body
5. Keep a well-balanced diet
6. Avoid drugs, alcohol, tobacco, and caffeine: actually worsen symptoms (may seem like they are helping you in the beginning)
7. Exercise: 30 minutes of aerobic exercise
Shh... Secrets
1. CBD: signals to release serotonin, has been commonly used to treat various medical ailments however, there is no FDA approval at this time. If you are getting a CBD product, obtain a Certificate of Analysis to know what ingredients are in your product. There is promising data but no evidence at this time on its effect in humans.
2. Ashwagandha: an adaptogen that modulates response to stress or change in environment. A part of Ayurvedic medicine which helps your body to cope with external and internal stressors. Thought to work on decreasing cortisol levels. Not FDA approved at this time. Not to be used in pregnant women as it can cause preterm labor.
Please use these products with caution. No formal recommendation can be placed regarding CBD or Ashwagandha at this time. Consult your primary care physician before using any of these products especially, if you have other medical conditions or take any medications.
3. Meditate with HeadSpace! This app is a life saver and we both use it! https://www.headspace.com/headspace-meditation-app
4. Mindfulness! Here's the course Samantha completed: https://palousemindfulness.com/. It's a free online course specializing in Mindfulness-Based Stress Reduction!
Samantha's favorites:
"I use this product every night before going to bed. I start by applying some pressure over my temples, then across my forehead and chin. I also hold my hands together over my nose and mouth, close my eyes and take in the calming effect of the lavender scent. Finally, I apply the oil over the rest of my face, neck, and chest in a circular motion" - Samantha
Adelynn's favorites:
11. Youtube: Sleep Hypnosis like Adelynn does when she can't fall asleep!
12. Yoga: combination of postures, breathing exercises, and meditation. Really an amazing way to workout, stretch, and release negative thoughts as well as, energy.
That's all for this week, don't forget to leave us feedback and send in your questions so we can continue to improve as well as, provide you high quality content!
Disclaimer: The Content on our podcast/website is not intended to be a substitute for professional medical advice, diagnosis, or treatment. Always seek the advice of your physician or other qualified health provider with any questions you may have regarding a medical condition. Never disregard professional medical advice or delay in seeking it because of something you have read on this website.