Anxiety is Common

While many people feel anxious at one time or another, for some anxiety becomes overwhelming and interferes with everyday functioning. If you are one of these people, you are not alone. The National Institute of Mental Health website states that about 18% of Americans suffer from Anxiety Disorders in any given year.

• The Anxiety and Depressive Disorders Association estimates that 40 million people older than 18 suffer from anxiety. The condition often goes untreated even though assistance is available.
• Anxiety can come in many different shapes and sizes. It can affect children and adolescents as well as adults. Anxiety is usually characterized by intolerance of uncertainty and the distress this causes.

Read about specific Anxiety Conditions by selecting the links which follow:

There are a number of CBT treatment interventions that apply to many Anxiety Disorders.

Read more about CBT Treatment for Anxiety

Generalized Anxiety Disorder (GAD)

You may be suffering from Generalized Anxiety Disorder (GAD) if:

• Your worries seem uncontrollable.
• You worry about everyday things every day, and worry interferes with your daily activities.
• Worry has been present for more than 6 months.

When worry becomes unrelenting, it can both create and perpetuate anxiety by maintaining dysfunctional thoughts and images associated with imagined future danger and threats.

If you have GAD you may think your worry has a positive value. Some think that their worry prepares them to cope more effectively. Some worriers believe that their worry prevents the occurrence of an undesirable future event and thus eliminates danger and allays distress.

In the circumstances described above, the CBT therapist will put these beliefs into question and work with you to examine and evaluate their validity.

Some Symptoms of Generalized Anxiety:

• You are unable to relax.
• You may have trouble with sleep.
• You have difficulty concentrating.
• You may experience some physical symptoms such as feeling lightheaded, or being short of breath.
• You may have headaches, muscle tension, aches or excessive sweating.

Read more about CBT Treatment for Anxiety

Social Anxiety

Estimates from the Anxiety and Depression Disorder Association of America (ADAA) suggest that 15 million adults or 6.8 % percent of the adult population suffer from Social Anxiety. Childhood or adolescence is the typical stage when the condition begins, with 13 years of age being the typical age of onset.

Social Anxiety, commonly called Social Phobia, exists when a person has a persistent fear of one or more social situations. The person fears acting in a way which he/she believes could become embarrassing or humiliating and potentially result in criticism or rejection.

Triggers for Social Anxiety

Often there are two principle situations which trigger Social Anxiety:

1. Interpersonal interactions in a social situation, such as approaching and speaking to a stranger at a party
2. Fear of being observed by others, often with fears of public speaking or in children, fear of interacting with peers

Individuals with Social Anxiety will often avoid situations which involve an interpersonal or performance-related component.

• This avoidance can result in significant difficulties at work or at school. Additionally, it can negatively impact friendships and romantic relationships.
• The anxiety is fueled by a variety of means such as resorting to safety behaviors (behaviors used to prevent unwanted social mishaps) or shifting to an internal focus of attention.

Treatment for Social Anxiety employs a variety of methods including relaxation techniques, cognitive structuring, exposure, and behavioral experiments.

Read more about CBT Treatment for Anxiety

Phobias

The NIMH estimates that 19.2 million American experience phobias, defined as excessive and irrational fears of an object or situation. If you suffer from a phobia you may have tried to cope by anticipating the anxiety and avoiding the situation or object. When the avoidance fails, the fear becomes overwhelming and mild anxiety to intense panic is experienced.

For a specific fear to be classified as a phobia it must interfere with your ability to function or be extremely distressing. For example, if a person develops a fear of flying and his/her work requires frequent air travel, this condition would be considered a phobia if he/she becomes unwilling to fly.

Similarly, if a parent develops or has a fear of flying (Aviophobia) and because of the fear refuses to take a family vacation which includes a flight, the avoidance of the flight would also be considered a phobic response.

A person need not avoid a feared object or situation 100% of the time to be said to have a phobia, rather the determinant is whether significant distress is elicited by the situation.

Phobias involve varying themes such as the fear of being trapped (Claustrophobia), the fear of losing control or of the feeling of accompanying disgust.

An example of maintaining a phobic belief is, when fearing an MRI machine, you might think:

“If I started to panic no one would know or hear me, and I would fall apart without anyone coming to my rescue.”

There are many different objects and situations which spark phobic reactions.

• Fear of bridges, tunnels, driving, heights, flying, elevators or being confined are common.
• Fear of animals, insects and reptiles are common triggers for phobic patients.
• Many fear having needles or having blood drawn.

Phobias can be treated with Cognitive Behavioral Therapy.

In order to arrange a consultation with Dr. Schonberg call her at (908) 273-3133, after reading the Insurance section of this website.

Read more about CBT Treatment for Anxiety

Separation Anxiety

While some degree of Separation Anxiety is developmentally appropriate for infants between 14-18 months of age, the fears should start to gradually dissipate over time after that age. Children may have bouts of separation anxiety when beginning school or pre-school, but can normally be calmed down after a time with both distractions and reassurance that the parent will return. Some children maintain the behavior longer than others with it continuing through elementary school.

Separation Anxiety Disorder is characterized by developmentally inappropriate extreme worry about being separated from a figure to whom one is attached.

• Extreme distress is experienced when thinking about or when separated from that person or from home.
• Accompanying thoughts often involve fears of losing the person, or fear that harm will befall that person.
• As a result a child may cry, fear sleeping alone or become clingy.
• Some children also develop physical symptoms like sweating, nausea, or shortness of breath.

• The degree of distress the child or person experiences and the disruption of normal activities are markers used to determine whether true Separation Anxiety Disorder is present. For example, worry about a first sleepover is not an uncommon concern with children, but repeated refusal to have a sleepover may be indicative of an unexpressed fear.

• Separation Anxiety Disorder could result in a child refusing to go to school, to go on a playdate, on a sleepover or to sleep away camp and, as a possible result, experience ridicule from siblings or peers.

One key to treatment of this condition in children is involving the parent in the therapeutic process to help change negative thought patterns, teach relaxation techniques and ultimately allow the child to experience graduated exposure to the feared separation.
Read more about CBT Treatment for Anxiety

Panic Disorder

Panic “attacks” are distinct from anxiety as the sensations experienced represent a response to an immediate state of perceived danger. Anxiety, in contrast, results from the fear of some future threat.

Panic attacks may result when a person interprets his or her physical sensations in a worrisome manner.

• For example, a racing heart or sweaty palms may be misinterpreted as a heart attack and then result in a person’s experiencing a panic attack.
• Similarly, a feeling of lightheadedness may be accompanied by a fear of passing out and being embarrassed in front of others.

Panic attacks can be triggered by specific situations or their onset can seem mysterious, even occurring during the middle of the night. At times, Panic Disorder is accompanied by Agoraphobia, which involves the pervasive avoidance of certain places, in an effort to prevent the onset of the panic. The latter can become quite disabling as a person’s “safe” zone continues to shrink over time.

Help is available for Panic Attack sufferers.

You can contact Dr. Schonberg at (908) 273-3133 to arrange for a consultation.
Read more about CBT Treatment for Anxiety

Health/Illness Anxiety

Health Anxiety is characterized by the preoccupation with or the fear of having a serious illness, or a belief that one will develop a serious illness in the future.

A person suffering from Health Anxiety will often misinterpret benign symptoms or body sensations as indicative of a serious illness giving rise to anxiety. The belief and anxiety persist in spite of assurances from medical professionals, trusted family or friends.

• Checking behaviors may also persist and take the form of surveying and resurveying one’s body for signs of the onset or worsening of the feared medical condition. Repeatedly checking medical websites on the internet for diagnostic and related information is another form of a checking behavior.
• Invariably these attempts to seek reassurance have the opposite effect and actually exacerbate the anxiety.

A cycle can develop where resorting to ‘safety behaviors’ in an attempt to reduce anxiety results in the worsening of the anxiety. Similarly, hypervigilance regarding minor physical symptoms can actually reinforce the fear that one has a serious disease.

Health Anxiety Treatment

Treating Health Anxiety involves a variety of interventions. Learning to limit and halt the use of safety behaviors is a key therapeutic component. Additionally, various forms of exposure using a collaboratively developed fear hierarchy are utilized in conjunction with targeted cognitive restructuring.

Read more about CBT Treatment for Anxiety

Post-Traumatic Stress Disorder

PTSD is a condition that arises following a person’s being exposed either directly or indirectly (as a witness) to an actual or threatened death, significant injury or act of sexual assault. The individual will re-experience (re-live) the traumatic event through flashbacks or nightmares. PTSD can be experienced in adults and in children.

Precipitating events can include:

• Serious Motor Vehicle Accidents
• Engulfing fires
• War Trauma
• Terrorism
• Sexual Violence

A person will often attempt to avoid thoughts, feelings, places or people associated with the traumatic event. They will also experience varying states of hyperarousal including irritability, insomnia, startle reactions or poor concentration. Mood changes such as persistent fear, anhedonia (inability to experience pleasure), guilt or shame can also result.

Treatment Techniques for PTSD

The treatment can include a combination of Cognitive Therapy, Exposure Therapy and Relaxation Training. Elements of Cognitive Therapy would aim to modify erroneous thoughts about the sense of current threat.

Examples of such cognitions are:

• “The world is a dangerous place.”
• “I can never protect myself again.”
• “I am now permanently damaged.”

Cognitive restructuring would be employed to target such maladaptive beliefs.

• Exposure Therapy (both Invivo & Imaginal) are also used to enable the individual to habituate to the state of heightened arousal triggered by memories of the original traumatic event. Read more about ERP.

Relaxation training (including the teaching of diaphragmatic breathing) may also be used, particularly at the beginning of therapy, to diminish anxiety levels.

CBT Approaches to Anxiety Treatment

CBT treatment for Anxiety involves both cognitive and behavioral components.

Some cognitive aspects of treatment include the following:

Clients are taught to become aware of the situations that trigger anxiety, to self-observe and to monitor their responses in specific situations. Worksheets called “thought records” are used to help facilitate this process.

Identifying dysfunctional automatic thoughts is a key component of treatment in CBT. We think of these thoughts as irrational cognitions about a situation that influence a person’s behavior.

• An analysis of the written thought records is undertaken to assist in identifying dysfunctional automatic thoughts.
• This part of the process involves identifying the thoughts, categorizing the thought patterns and reappraising the thoughts.
• Ultimately, the core beliefs that occur in the presence of events which evoke anxiety are also investigated.

Some behavioral aspects of treatment include the following:

• Relaxation training techniques may be employed to help manage the physiological arousal symptoms of anxiety. These techniques can include Progressive Muscle Relaxation, Visual Imagery and Diaphragmatic Breathing.
• Systematic Desensitization is another behavioral treatment technique used in the treatment of Anxiety Disorders. Visit the “What is Cognitive Behavioral Therapy” page to see a short explanation of this treatment technique.

Most important, please keep in mind that Anxiety Disorders are treatable. If you believe you are suffering from an Anxiety Disorder and would like to explore treatment options, you can contact Dr. Schonberg at (908) 273-3133 to arrange a consultation.