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Anxiety and Anxiety Disorders

Through Her Mind: Generalized Anxiety Disorder

“But a caged bird stands on the grave of dreams

his shadow shouts on a nightmare scream

his wings are clipped and his feet are tied

so he opens his throat to sing.”

-Maya Angelou

It is difficult to grasp the true weight of experiencing an Anxiety Disorder. My roommate this semester has been diagnosed with Generalized Anxiety Disorder and Major Depressive Disorder. With her permission, I conducted an interview to understand what her experiences with anxiety have been like. Being so close to the source and helping her through this rough time, I have also made my own observations, and experiences which will be discussed below.

Question: Are there any questions that you find people ask you too often?

Response: I think the question I get the most often is “How are you?”. It is not a bad question but asking it over and over again does not change my response nor does it make me feel better. Other common questions are “Have you been better lately?”, “Is there anything I can do for you?”, “Are you feeling any better?”. I always appreciate the concern but the circumstances don’t change. It’s like being set on fire and someone asking the same question, the circumstance is horrendous, it hasn’t changed and the question doesn’t help to smother the flame.

Q: What coping mechanisms have you found most beneficial?

R: Checking the facts, distraction, exercising and holding ice cubes have helped. The three I mentioned first are Dialectical Behavioral Therapy skills. Checking the facts is a great skill because it allows me to realize how justifiable my emotions are in a situation. Distraction is great because when you are drowning in stress and misery this skill allows you to step away, gather yourself and then conquer it later. For me exercising and holding ice cubes are the blurred line between self-harm and coping. While they do distract me from my current situation, the physical pain from the workout or from the ice cube that slowly numbs my hand fuels me to keep going. As I reach my threshold for pain tolerance it helps me feel like I am in control of what happens and takes my mind off of the emotional and mental pain.

Q: Have your interactions changed since sharing your diagnosis with others? If so, how?

R: Everything changed. While I had a few trusted people that saw the signs of my illness and accepted it, they become more worried about me than I would have wished. I have begun to feel very alone and mute since I was “labeled”. Everyone is so eager to help me get better that they are literally throwing themselves at me. While there is a sense of support, I feel pressure because they all want to see results that I don’t think I am capable of giving them. Too much of a good thing is never good and sadly that applies to good intentions too. It is hard to explain to people who “check up” on me every day that I am not getting better and that even though I am in a crowd of caring voices I feel alone, mute, and lost.

Q: What does Anxiety feel like for you?

R: Anxiety is like having my phone constantly buzzing with reminders but not being able to turn it off because some part of me needs it. I may wish to decrease the amount of reminders or silence the volume. But, I can not distinguish which reminders are valuable and which ones are not.

Q: What does depression feel like for you?

R: It is more than the feeling the world is over because you failed a test. It is the constant assurance of being a failure and a burden to others just by existing.

Q: What advice would you give or have you given to your friends that are still in the hospital?

R: I would tell them that even though today is awful, you have to just get through it in hopes that tomorrow will be a better day even if you truly believe that it won’t be. We may not have chosen this mental illness, but it chose us. All we can do it try to take back control one day at a time…if that’s even possible.

My roommate has come a far distance but definitely has further to go. Each day is a battle of life falling apart quicker than she can pick up the pieces and before she realizes the pieces turn to dust unable to be mended back to its original form. Yet, she has to proceed with everyday activities while managing anxiety and battling depression. Many days turn out well, but each still feels as bad as the last.  Although she may not believe the next day will be better, she has the courage to proceed, refusing to allow these illnesses to control her. This journey of my roommate has been tough to witness and seems to encounter a new phase every week. Yet, I am constantly reminded of the analogy of being a caged bird. In the midst of all this darkness and difficulty she still sings hoping that this season will soon pass. Longing to be freed from the shackles of anxiety and depression, she shall not be defeated.

References:

Sara Biljana Gaon. (2015 June 25). Caged Bird [image]. Retrieved from https://www.flickr.com/photos/sarabiljana/25482708874

Maya Angelou. (1969). I know why the caged bird sings [poem]. Retrieved from https://allpoetry.com/I-Know-Why-The-Caged-Bird-Sings

Categories
Anxiety and Anxiety Disorders

Social Anxiety Disorder and Body Language

“Care about what other people think and you will always be their prisoner”

– Lao Tzu

In a society ruled by virtual interactions and relationships, it almost seems normal to approach social situations with awkwardness. When meeting new people or interacting with a crowd the common response is shyness. However, after a few minutes, it becomes easier to be more vulnerable and engaged with the once unfamiliar bodies, faces, and voices. Yet, for individuals with social anxiety disorder self-consciousness escalates and consumes not only the person’s thoughts but also their actions. Social anxiety is the intense fear of being judged, evaluated negatively or rejected by others in social situations. 

Individuals with social anxiety disorder may experience distress in situations such as going to social gatherings, using public restrooms, eating in front of others, talking with strangers, and making eye contact. In uncomfortable situations, social anxiety disorder can manifest itself into physical symptoms such as rapid heartbeat, muscle tension, dizziness, trembling and/or diarrhea. On the other hand, physiological or behavioral symptoms may include: avoidance of social interactions, intense fear of embarrassment, and having anxiety in anticipation of a social event. Social anxiety may be influenced by genetics, prior negative experience or embarrassment, or an overactive amygdala, which is responsible for fear. Common treatments for social anxiety include cognitive behavioral therapy (CBT), exposure therapy, group therapy and certain medications. CBT is typically used for reframing negative thoughts, controlling anxiety through relaxation, and can help an individual learn practical social skills. Exposure therapy is used to gradually expose the individual to stimuli that makes them fearful. Similarly, group therapy allows the individual to overcome their fear of social situations by interacting and role-playing with individuals who are also experiencing social anxiety. Lastly, medications such as antidepressants, beta-blockers, and anti-anxiety medication are commonly given as treatments for social anxiety disorder. These forms of medication work by suppressing the effects of norepinephrine which is a stress hormone or by inhibiting the re-uptake of serotonin and other ‘feel good’ hormones thereby allowing them to circulate in the blood and body a bit longer. 

A less commonly used form of treatment may include understanding and identifying the significance of body language. Certified fraud examiner and body language expert Vanessa Van Edwards believes that understanding body language is the key for liberation from social anxiety. In Edwards’ opinion, body language is like a human cipher, it reveals a set of values you can use to figure out motivations, values, how to speak to people and how to make people feel loved. In addition, Edwards mentions that understanding facial structures can be beneficial to understand emotional expressions. However, it is vital to first understand the baseline or normal expression and observe the changes that occur with different emotions. In the book “What Every Body is Saying”, FBI agent Joe Navarro decodes certain aspects of body language. For example, Navarro mentions that neck touching reveals discomfort, doubt or insecurity, and that eye deflection reveals distrust. Understanding the way a person walks can also reveal how they feel in that moment and where they want to go (either to leave or to stay). From the photo provided above, one can read varying emotions of shame, anger, pride, apathy, happiness, and sadness that each face expresses.

Understanding these forms of body language and what they mean can help individuals with social anxiety feel more comfortable in certain situations through the ability to read their environment and the people surrounding them. Knowing how people move, and observing their facial expressions can make social situations less fearful and offers an escape from catastrophizing thoughts. The use of body language can help individuals experiencing social anxiety to alter the way other people perceive them and offer an outlet by truly understanding the behaviors of others.

References:

Anxiety and Depression Association of America. (2016). Understand the facts: social anxiety disorder. Retrieved from https://adaa.org/understanding-anxiety/social-anxiety-disorder

[Improvement Pill]. (2017, May 18). The cure for social anxiety. [Video file]. Retrieved from https://www.youtube.com/watch?v=tAT9vhcmdSE

Bilyeu, T. (2017, Aug. 1). Liberate yourself from social anxiety. [Video file]. Retrieved from https://www.youtube.com/watch?v=X8CD2QEYo6Q

Paul Ekman Group. (2015). 5 signs of lying that aren’t as foolproof as you’d think. Retrieved from https://www.paulekman.com/facial-expressions/signs-of-lying/  

Pierce, T. (2009). Social anxiety and technology: face-to-face communication versus technological communication among teens. Computers in Human Behavior, 25(6), 1367-1372. Retrieved from https://www.sciencedirect.com/science/article/pii/S0747563209000971

Cherry, K. (2018). How to understand body language and facial expressions. Retrieved from https://www.verywellmind.com/understand-body-language-and-facial-expressions-4147228

Gootman, E & Newman, A. (2011). That look, That Weiner-Spitzer-Clinton look. Retrieved from https://cityroom.blogs.nytimes.com/2011/06/07/that-look-that-weiner-spitzer-clinton-look/

Navarro, J. (2008). What every body is saying. Retrieved from https://www.goodreads.com/work/quotes/1161341-what-every-body-is-saying-an-fbi-agent-s-guide-to-speed-reading-people

National Institute of Mental Health. (n.d.). Social anxiety disorder: more than just shyness. Retrieved from https://www.nimh.nih.gov/health/publications/social-anxiety-disorder-more-than-justshyness/index.shtml

Higuera, V. (2016). Social anxiety disorder. Retrieved from https://www.healthline.com/health/anxiety/social-phobia

Mayo Clinic. (2017). Social anxiety disorder (social phobia). Retrieved from https://www.mayoclinic.org/diseases-conditions/social-anxiety-disorder/symptoms-causes/syc20353561

WebMD. (2017). What is social anxiety disorder? Retrieved from https://www.webmd.com/anxiety-panic/guide/mental-health-social-anxiety-disorder#1

Categories
Anxiety and Anxiety Disorders

Beyond Medication: You Have Options

“Let food be thy medicine and medicine be thy food”

-Hippocrates

Before becoming a physician, many medical students take an oath commonly referred to as the Hippocratic Oath. This code of ethics not only dictates the roles of physicians, teachers, and students of medicine but also requires physicians to make a commitment to only provide beneficial treatments, reduce the risk of harm and refrain from corrupted or mischievous behaviors. The code also mentions controversial topics such as a physician’s role of engaging in abortions and euthanasia. Social, economic and political changes have influenced the modification of the oath. But, in doing so it is possible that Hippocrates’ intent has been ignored. Although little is known of this Greek “Father of Medicine”, he was a huge proponent of holistic, natural or as we say today alternative medicine.

Natural medicine has been overlooked and outsourced to make room for pharmaceutical medication. While pharmaceutical medication, which has become the conventional form of medicine proves to be beneficial, it is commonly used as a sole source of treatment rather than a supplement to natural remedies. Natural medicine may involve the use of acupuncture, pilates, meditation, therapeutic massages, proper nutrition and the use of herbs such as sage, rosemary, ginger, and lavender. However, these unregulated sources of treatment prove as a threat for multi-billion dollar pharmaceutical industries such as Pfizer and Johnson & Johnson. While the FDA regulates medication for safety and efficacy for Americans, there is an overabundance of medication and pharmaceutical companies the department is responsible for. Therefore, it takes a while before pharmaceutical companies are fined for mislabeling and/or over-promoting their medication for use by vulnerable populations such as individuals under the age of 18 or those with a mental disorder.

Individuals experiencing mental illness such as depression or anxiety, consent to pharmaceutical medication with an inordinate amount of side effects usually without the option to pursue holistic treatments. For example, pharmacotherapy and psychotherapy medications such as benzodiazepines, serotonin reuptake inhibitors, buspirone, and pregabalin are commonly prescribed to patients diagnosed with Generalized Anxiety Disorder. However, they carry side effects such as dizziness, sedation, agitation, amnesia, insomnia, and organ damage, thereby creating a paradoxical effect of worsening anxiety disorder symptoms and creating new ailments. On the other hand, herbs such as passionflower and kava have been shown to reduce nervousness, anxiety, and insomnia in patients diagnosed with Generalized Anxiety Disorder and show less side effect than their pharmaceutical counterpart.

No treatment is perfect. Both herbal medicine and pharmaceutical medicine have risks of side effects and both industries make large profits in the realm of health. However, natural medicine is significantly cheaper than conventional forms of medication but is rarely given as a treatment option. A study published in the Journal of Health Services Research revealed that doctors will commonly use natural remedies for their illness but will not recommend them to patients. Therefore, consumers are left with the responsibility of understanding and expanding their options, yet many are unaware that they even have an option. Maybe it is easier to prescribe medication than to try convincing individuals to make positive lifestyle changes. But, why settle for less with our health. Don’t we deserve to have options?

References:

Bystritsky, A. (2018). Pharmacotherapy for generalized anxiety disorder in adults. Retrieved from https://www.uptodate.com/contents/pharmacotherapy-for-generalized-anxiety-disorderinadultssearch=anxiety&source=search_result&selectedTitle=1~150&usage_type=default&display_rank1

Calm Clinic. (n.d.). Dangerous anxiety medication side effects. Retrieved from https://www.calmclinic.com/anxiety/drugs/side-effects

Encyclopedia Britannica. (2018). Hippocratic Oath. Retrieved from https://www.britannica.com/topic/Hippocratic-oath

Independent Vital Life. (2016). Why doctors do not prescribe natural alternatives. Retrieved from http://www.ivlproducts.com/HealthLibrary/HealthConcerns/SupplementVitaminsWelness/Why-Doctors-Do-Not-Prescribe-Natural-Alternatives/

Herbs vs. drugs: get the facts about medicine. Retrieved from https://www.motherearthnews.com/natural-health/herbs-vs-drugs-facts-about-medicine-zmaz06djzraw

Lakhan, S & Vieira, K. (2010). Nutritional and herbal supplements for anxiety and anxiety-related disorders: systematic review. Retrieved from https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2959081/

Smith, M., Robinson, L., & Segal, J. (2017). Anxiety Medication: What you need to know about benzodiazepines and other anxiety drugs. Retrieved from https://www.helpguide.org/articles/anxiety/anxiety-medication.htm

Smith, W. (2018). Hippocrates. Retrieved from https://www.britannica.com/biography/Hippocrates

Trueman, C. (2015). Hippocrates. Retrieved from http://www.historylearningsite.co.uk/a-history-of-medicine/hippocrates/

Zerbe, L. (2011). Docs use natural remedies (but don’t prescribe them). Retrieved from https://www.rodalewellness.com/health/natural-remedies-0

Categories
Anxiety and Anxiety Disorders

Mastering Your Mind: Cognitive Distortions

Anxiety is like having new tabs opening very quickly [on your computer] one after another and not being able to close them or stop new ones from opening — but in your head. It happens while working, taking care of kids, driving, answering questions, and a million other things that people do in a day.”

– Unknown

While there are many visible physical symptoms of anxiety such as sweaty palms, increased heart rate, shortness of breath and muscle twitches, some of the most damaging symptoms remain captured in the mind. Many individuals with anxiety can experience overwhelming, intrusive and unrelenting thoughts that interfere with their daily productivity.

While the exact cause of anxiety is unknown, cognitive distortions are believed to be a factor in the development and maintenance of this mental illness. Cognitive distortions are irrational thoughts and beliefs that are reinforced over time and have the potential to cause psychological harm. Clinical psychologist Jeffrey DeGroat believes that anxiety arises when a person’s cognitive distortions, or irrational thought patterns, make them see everything as a physical threat, whether it’s an actual physical danger or not. For example, almost getting into a car accident is a physical threat. But, having a cashier at the supermarket engage you in conversation is not an actual physical danger. 

Two of the most common forms of cognitive distortions include: mental filtering and jumping to conclusions. Mental filtering is the inability to focus on the positive aspects of a situation.  Individuals with this cognitive distortion tend to see the glass as half empty rather than half full. This mentality can become problematic, as it may result in depressed mood, low self-esteem, and pessimism with an associated feeling of incompetence. On the other hand, jumping to conclusion is the premise that individuals believe something despite not having accurate evidence to support it. This cognitive distortion is comparable to buying a house without looking on the inside simply because the outside looks nice with freshly cut lawn. Jumping to conclusion not only has a negative effect on the individual but also makes judgments about the surrounding things or people. Similarly to mental filtering, this comparison mentality encourages pessimism, feelings of inadequacy and may foster other mental illnesses such as depression.

However, hope is not lost when battling with cognitive distortions. There are many methods and beneficial techniques that can help slow down and combat these anxious thoughts. Reframing, for example, is a strategy used to alter one’s perspective on a specific situation. This technique provides an optimistic strategy to an otherwise negative situation by identifying and invalidating the thoughts. Getting thoughts down on paper and journaling is another method used to combat intrusive thoughts as it allows the individual to identify a thought, focus on what triggered it and then dissect it. Through this method, individuals can destroy the validity of certain thoughts so that when they arise again, they will be easier to combat. Lastly, research suggests that affiliative and self-enhancing humor can be a beneficial strategy to cope with cognitive distortions. Affiliative humor is used to amuse others and minimize tension while self-enhancing humor is the use of humor in the face of adversity. Therefore, maybe laughter is indeed the best form of medicine.

Overall, while cognitive distortions may be a factor in the development of anxiety disorders, the presence or absence of the aforementioned distortions, neither confirms nor denies a proper diagnosis of anxiety. While these cognitive distortions may become overwhelming, there are different methods available for coping, such as journaling or using humor. With these strategies, those struggling with anxiety and cognitive distortions can take positive steps to become masters of their own mind.

References:

Ackerman, C. (2017). Distortions: when your brain lies to you. Retrieved from https://positivepsychologyprogram.com/cognitive-distortions/

Hamilton, J. (2008). Think you’re multitasking? Think again. Retrieved from https://www.npr.org/templates/story/story.php?storyId=95256794

Henry, A. (2013). What anxiety does to your brain and what you can do about it. Retrieved from https://lifehacker.com/what-anxiety-actually-does-to-you-and-what-you-can-do-a-1468128356

Musallam, F. (2016). 24 Quotes that show what it’s really like to live with anxiety. Retrieved from https://themighty.com/2016/04/anxiety-quotes/

Rnic, K., Dozois, D., Martin, R. (2016). Cognitive Distortions, Humor Styles, and Depression. Europe’s Journal of Psychology. 12(3). 348-362. doi:  10.5964/ejop.v12i3.1118

Seltzer, L. (2017). What’s emotional reasoning – and why is it such a problem? Retrieved from https://www.psychologytoday.com/blog/evolution-the-self/201706/what-s-emotional-reasoningand-why-is-it-such-problem

Smith, M., Robinson, L., Segal, J. (2018). Anxiety Disorders and Anxiety Attacks: recognizing the signs and symptoms and getting help. Retrieved from https://www.helpguide.org/articles/anxiety/anxiety-disorders-and-anxiety-attacks.htm

Star, K. (2018). Mental Filters and Panic Disorder. Retrieved from https://www.verywellmind.com/mental-filters-and-panic-disorder-2584186

Categories
Anxiety and Anxiety Disorders

Cutting-Edge Therapies for Selective Mutism

In the tenth episode of the sixth season of critically acclaimed legal-drama TV show called ‘Drop Dead Diva’, Kim Kaswell, one of the head lawyers, takes up a case regarding a ventriloquist who is accused of wrongly utilizing the Americans with Disability Act to gain a seat for his puppet in an airplane. When Kaswell goes to prison to bail him out, she finds him without his puppet. The ventriloquist is unable to speak properly, he stammers and struggles to communicate effectively. Without his constant companion, his puppet, he struggles to perform an activity he does for a living.

Ventriloquism is defined as the “production of the voice in such a way that the sound seems to come from a source other than the vocal organs of the speaker”; in this manner, an individual may express their ideas or feelings through a fictional character, commonly puppets.

The ventriloquist suffers from selective mutism, an anxiety disorder defined by the American Psychiatric Association as “consistent failure to speak in certain social situations where there is a natural expectation of speaking” due to anxious thoughts. With the help of his puppet, the character is able to overcome his anxiety of speaking and effectively connects with his audience. Today, many such projective techniques are employed to treat selective mutism. Masks may also have a similar remedy for those seeking treatment for selective mutism.

In addition, drama therapy defined as “the intentional use of drama and/or theater processes to achieve therapeutic goals,” utilizes a unique form of therapy for selective mutism.  A case study done involving Gladys, a 5-year-old girl diagnosed with selective mutism, found that drama therapy, when offered “ in the context of play, with play as the primary reinforcer” brought out speech within a tense period of time (Oon, 2010). This improvement allowed her to join dramatic play and speak spontaneously. This case study observed the effects of the main elements of drama therapy: the playspace, role-playing, and dramatic projection. Gladys’s self-esteem and sense of spontaneity increased. Subsequently, these two qualities helped her generalize her speech to new settings on her own. Gladys’s newly harnessed spontaneity further helped her become more sociable and comfortable. This study advances the possibility of integrating a behavioral skill with drama therapy for therapeutic benefits of a child with an anxiety-related condition like selective mutism.

Such novel approaches to selective mutism have been successful in remodeling the social worlds of individuals without the sober tone that therapy can sometimes entail. Unaccompanied by an emphasis on their anxiety disorder, children and adolescents may benefit from unconventional therapies that focus on developing the individual rather than the illness.

References:

Drop Dead Diva RECAP 6/1/14: Season 6 Episode 10 “No Return”. (n.d.). Celebrity Dirty Laundry. Retrieved December 01, 2017, from https://www.celebdirtylaundry.com/2014/drop-dead-diva-recap-6114-season-6-episode-10-no-return/

What is Drama Therapy? (n.d.). North American Drama Therapy Association. Retrieved December 01, 2017, from http://www.nadta.org/what-is-drama-therapy.html

Sound Advice – Selective Mutism Foundation. (n.d.). Selective Mutism Foundation. Retrieved December 01, 2017, from https://www.selectivemutismfoundation.org/info-on-selective-mutism/sound-advice

Playing with Gladys: A case study integrating drama therapy with behavioural interventions for the treatment of selective mutism. (n.d.). Sage Journals. Retrieved December 01, 2017, from http://journals.sagepub.com/doi/abs/10.1177/1359104509352892

Categories
Anxiety and Anxiety Disorders

The Unspoken: Anxiety and the Church

“The Bible says it, I believe it, that settles it” 

-Kenneth Hagin

“Do not be anxious about anything, but in every situation, by prayer and petition, with thanksgiving, present your request to God. And the peace of God which transcends all understanding will guard your hearts and your minds in Christ Jesus”

Philippians 4:6-7

Often times with good intentions, mature Christians may sometimes give this verse to individuals suffering with anxiety. But overcoming an issue can sometimes be more difficult than a simple phrase can solve. Usually, miscommunications can occur because the signs are not visually obvious. Similar to a headache, there may not always be external indicators to make anxiety appear as a problem. Therefore, because anxiety is not tangible we may not believe that it actually exists or we simply don’t know the best strategy to combat it. But, to the individual experiencing it, it is real and it is difficult to get through. In this case, though intentions are pure, simply quoting a bible verse may not always be the best way to approach the situation when someone confides in you with their mental health struggle.

Despite technological advances in the health field, the exact cause of anxiety is unknown. Anxiety disorders go beyond everyday stress and may sometimes involve feelings of excessive fear or worry that interfere with progress and functionality. With anxiety disorders, the body reacts as if danger is present when there is no actual threat. The body sounds all the alarms to the sympathetic nervous system to prepare for fight or flight, when in truth no harm is present. This overactivity of the bodily systems could result in fatigue or have other damaging effects. Many people with anxiety may have difficulty concentrating, trouble sleeping, experience irritability, or have racing thoughts. Though the struggle with this mental illness may seem endless, there is hope because anxiety disorders are highly treatable. Nevertheless, while approximately 44 million adults in the United States suffer from anxiety disorders, only one-third of those struggling actually seek and receive treatment. Professor and clinical psychologist Ryan Howes believes that many people do not seek out therapy or other forms of treatment because they feel ashamed or embarrassed. Society has placed a negative connotation on seeking help in general as it may be perceived as a sign of weakness, and even more so as it relates to mental illnesses. This concept could become especially damaging to individuals who feel as though they have to live up to a certain reputation to fit into their cultural, racial or religious group.

According to Focus On The Family, a Christian faith-based website, stigmas within the Christian community is a major factor why individuals may not seek help or even admit that they are suffering with an anxiety disorder. Some Christians may feel hopeless and begin to believe that this battle is a sign of spiritual failure. Yet there are many biblical figures that have faced their own battles with spiritual and mental health.

Mental illness is not always the result of a spiritual struggle. However, religious ideologies and criticism from fellow believers could negatively impact one’s mental health. Though there is limited research on the topic of religion and Christianity, a study performed by Kenneth Kendler and colleagues, revealed that different religious aspects could dictate someone’s relationship with a mental illness. Internalizing disorders include depression, generalized anxiety disorder, and panic disorder. On the other hand, externalizing disorders involved issue relating to substance abuse or dependence. According to Agorastos et al, negative religious perceptions could include beliefs that God has abandoned that individual or is punishing them, and worsen internalizing disorders such as anxiety. On the other hand, positive religious behavior including worship, fellowship, thankfulness, prayer and reading the bible was associated with better mental health, thereby reducing (not eradicating) both externalizing and internalizing disorders. This reveals, that even with a positive and devoted Christ following lifestyle, that individuals may still suffer from mental health issues.

Upon acknowledging that religious and spiritual resources do not make Christians absolutely immune to mental health issues, some may accept mental health as a serious issue worthy of taking note of. However, the response for ‘acceptable’ treatment could be burdensome. In her testimony, Christian singer, songwriter and inspirational speaker, Sheila Walsh, mentioned that she talked to a mother whose child was battling with mental health. She said, “My daughter has struggled for years with depression but she started to work with a church that doesn’t believe Christians should take medication. My daughter took her own life.” Though truly heartbreaking and painful to admit, more situations like this need to be brought to light. Everyone is different, and what works for one individual may not work so well for another. While there have been testimonies where through prayer and petition individuals have claimed receive instant healing from God, this may not always be the case. For example, Walsh mentions that medication has helped and she thanks God each day that He has made this resource available and possible for her.

Many are wary of using secular methods versus spiritual ones in the treatment of illnesses such as anxiety. However, psychologists are now beginning to understand the benefit of spirituality. For example, Kenneth Pargament an expert in the psychology of religion and spirituality mentions that psychologists are currently developing and evaluating spiritual integration into their treatment approaches (typically Cognitive Behavioral Therapy). Therefore, this once secular method of treating mental illnesses is now incorporating mantras from the Bible and utilizing other spiritual resources.

Nevertheless, regardless of the method of treatment whether it be medication or prayer for healing from anxiety, individuals should not be criticized for their choice. As aforementioned, many biblical figures have struggled with issues that did not arise from a lack of faith. For example, in the New Testament, Paul mentions that he had a “thorn in his flesh” (not a literal one). After pleading with God for its removal, God did not take it away but rather said, “My Grace is sufficient”. God lovingly denied this request so that in weakness, through Him believers could be made strong. Mental health is not an issue of faith. But, in the church, it may be an issue of perspective. We forget that many in the Bible have struggled and that God is not a magical fairy that grants our every wish.

The church may sometimes alienate and criticize fellow believers because of their battles. In doing so judgment takes root and makes people feel as though they have strayed away and that God is no longer willing to help them. However, that is not truly the case. The book of Romans mentions that nothing can separate anyone from God’s love. Through anxiety, depression or any other mental health battle, God’s love never ceases. Church can no longer be a place where individuals quietly suffer from their mental illness. We need to band together and permit these tough and awkward conversations. We need to listen, be respectful and offer a helping hand. We cannot solve issues if they remain to be hidden and unspoken.

References:

Agorastos, A., Demiralay, C., & Huber, C. (2014). Influence of religious aspect and personal beliefs on psychological behavior: focus on anxiety disorders. PMC journals. 7, 93-101. doi: 10.2147/PRBM.S43666

American Psychiatric Association. (2017). What are anxiety disorders? Retrieved from https://www.psychiatry.org/patients-families/anxiety-disorders/what-are-anxiety-disorder 

American Psychological Association. (2013). What role do religion and spirituality play in mental health? Retrieved from http://www.apa.org/news/press/releases/2013/03/religion-spirituality.aspx 

Anxiety and Depression Association of America. (2016). Understanding the facts of anxiety disorders and depression is the first step. Retrieved from https://adaa.org/understanding-anxiety

Graber, D. (2014). Anxiety Disorders- Frequently Asked Questions. Retrieved from https://www.focusonthefamily.com/lifechallenges/emotional-health/anxiety-disorders-frequently-asked-questions 

Kendler, K., Liu, X., Gardner, C., McCullough, M., Larsen, D., & Prescott, C. (2013). Dimensions of religiosity and their relationship to lifetime psychiatric and substance use disorders. The American Journal of Psychiatry. 160(3),  496-503.

National Institute of Mental Health. (2016). Anxiety Disorders. Retrieved from https://www.nimh.nih.gov/health/topics/anxiety-disorders/index.shtml

Smith, K. (2017). Free Stock Photo of Adult, Alone, Anxious. Retrieved from www.pexels.com/photo/adult-alone-anxious-black-and-white-568027/

Stetzer, E. (2013). Mental Illness and the Church: some helpful honesty from christian leaders you may know. Retrieved from https://www.christianitytoday.com/edstetzer/2013/april/mental-illness-and-church-some-helpful-honesty-from.html

Tartakovksy, Margarita. (2013). What prevents people from seeking mental health treatment? Retrieved from https://psychcentral.com/blog/what-prevents-people-from-seeking-mental-health-treatment/

Categories
Anxiety and Anxiety Disorders

When Your Furballs Get Too SAD

Big brown eyes with russet tear stains leading to their warm and moist snout, violently sniffing you every time you enter your home. Staring at you with complete adoration, but a hint of suspicion and accusation, almost saying: “Is that another dog I smell on you? How dare you? ” And yet there is love and wild excitement to see you – a love so pure that your heart never becomes immune to it. How often do we look to our canine friends for support?

For centuries humans have found a friend, and a reason to smile, in dogs. Today, for those who do not have dogs, sensational “puppy videos” are created and uploaded on social media and these provide relaxation to some. Their innocence, playfulness, and unconditional love are key for many individuals to deal with their anxiety disorders. These furballs distract them from their over-worked minds and soothe their nerves. However, what happens when these tail-waggers have an anxiety disorder? Dogs may stop eating or act in an unruly manner if their owner’s absence makes them nervous. Language has been a communicative barrier. We do not know what they are feeling; a wag of a tail, a lick, a bark, can all be interpreted differently by us humans. How can we tell if a dog’s anxiety is a persistent issue that may need treatment?

Twenty percent of the nation’s 80 million dogs have separation anxiety disorder or SAD, according to Dr. Nick Dodman of Tufts University’s Cummings School of Veterinary Medicine, and around 29 to 50 percent of senior dogs are affected (Borreli 2014). Dr. Dodman explains that dogs usually develop this disorder at a young age, and older dogs may develop an anxiety disorder as a response to their dependency on their owners when they are ill. They are not only loyal to their owners, but also very emotionally attached. Therefore, they may get anxious when separated from their owner. While we may not be able to understand dogs as clearly as another human who is able to communicate their anxiety to us verbally, there are defining symptoms in their behavior that can be observed if they suffer from separation anxiety, just like there would be in a human’s behavior. “Signs of separation anxiety are caused by a dog’s need to reduce tension or stress and only occur in the owner’s absence,” describes Dodman. “The most common complaints by pet parents is that their dogs are disruptive or destructive when left alone. They might urinate or defecate; bark and howl; or chew on objects, door frames or window sills,” he pointed out.  

Dianne Larson of California described her experience with her young black Labrador, Ruby, when her 14-year old son, Tanner, goes to school: “School started two weeks ago and Ruby still searches for Tanner when he’s gone. She stays in his room. If his door is closed, she will whine to get in. If she isn’t in Tanner’s room, she’s at the front window watching for him” (Borreli 2014). Experts say that dogs who suffer from this anxiety disorder may whimper frequently and refuse to eat when their owners absent. Dr. Dodman further explained, “There will be an exuberant greeting when you do come home, one that can last several minutes and be completely crazy, then the dog will run to the food bowl.”

There are several activities that pet-owners can engage their dogs in themselves to alleviate their anxiety. Some recommendations by Dr. Dodman are: walking your dog before you leave the house, leaving home with puzzles and toys for your dog to play with and keeping departures and arrivals “low-key.” If the severity of your dog’s anxiety persists, Dr. Stephanie Borns-Weil of Cummings School of Veterinary Medicine at Tufts University recommends a formalized independence training that aims to stop reinforcement of attention-seeking behavior, ensure the dog has plenty of mental and physical exercise because a “tired dog is a happier, more relaxed dog,” and several other techniques.

Dogs provide comfort and joy to countless individuals. The least we can do for them is to interpret their behavior correctly and identify their stress. We mustn’t take their unconditional love for granted and ensure their optimum mental health.

References:

Borreli, L. (2014, August 29). Puppy Love: Dogs Suffer Back-To-School Blues With Separation Anxiety From Kids, But Can It Be Treated? Medical Daily. Retrieved November 16, 2017, from http://www.medicaldaily.com/puppy-love-dogs-suffer-back-school-blues-separation-anxiety-kids-can-it-be-treated-300532

“I’ll Be Right Home”. (2017, June 30). Tufts University. Retrieved November 16, 2017, from http://news.vet.tufts.edu/2014/07/ill-be-right-home/

Categories
Anxiety and Anxiety Disorders

Foreseeing the Unforeseen: Anxiety and Romance

You were not expecting this. Your life has come to a standstill. Other people dismiss it as “teenage drama” and expect you to get over it. It’s frivolous and temporary, they think. It’s a transient phase in every teenagers’ life. Is that why you underestimate and dismiss your own feelings? You shove them away somewhere deep inside, plaster a smile on your face and hold your shoulders high, ready to face the world, as if it doesn’t affect you at all. But because of the termination of a romantic relationship in your life panic, fear and anxiety have set in. You’re not the same person anymore, but nobody can see it. The damage is not physical– there are no fractures or bruises, it is intangible.

Romantic relationships during adolescence are not uncommon. Dr. Wyndol Furman, an editor of the book ‘The Development of Romantic Relationships in Adolescence’ described adolescence as, ”a roiling emotional caldron whose major fuel — more than parents, peers or school and almost as much as those things combined”– is romance (Gallagher Nov 2001). While romantic relationships can provide companionship and joy, the termination of such a relationship, whether expected or unexpected, can cause emotional tribulations in the lives of the affected. Feelings of sadness and depression may be expected to occur in such a scenario, but feelings of panic or anxiety, especially when a person has never experienced it before, can be surprising and scary (Robboy).

An example of an who individual who expressed their surprise to the anxiety they experienced after their breakup on a relationship-anxiety forum, gives us insight into what it could feel like: “I also think I’ve been experiencing mini-anxiety attacks but I don’t really know. The only other time I’ve had an anxiety/panic attack was during a rough patch in my life. I don’t know how to control this especially since I’m a student who is fairly busy all day long” (upsided0wnn, 2017). Their words delineate confusion and doubt regarding the reality of her anxiety. Adolescents may experience this confusion because they are not informed about the symptoms and prevalence of different forms of anxiety disorders. Another crucial factor that may cause this confusion could be the assumption that symptoms are normal and what is expected after ending a romantic relationship. They may feel that being sad after a breakup is typical, but since anxiety after a breakup is less heard of or anticipated, they could be hindered from recognizing it.

Perhaps recognizing the cause of anxiety after a breakup could facilitate adolescents to anticipate it, and thus seek help or treatment. Sadness post-breakup can sometimes be an awaited emotion, and root cause of sadness may not impossible to decipher either. However, since the cause of anxiety may not be that easy to pinpoint, it could overwhelm them. Caroline Robboy, founder and executive director of a counseling organization in Philadelphia called Center for Growth Inc, explained why anxiety might be experienced after a breakup. She explained that since the discontinuation of a significant relationship engenders a major transition in a person’s life, they are bound to move into at least “some degree of unknown territory.” She further elaborated that anxiety is an “extremely normal feeling to have when facing the unknown.” This unknown territory could be in the form of not being able to rely on their partner for “social engagement, financial support or even life advice”, which was previously a major constant in our lives (Robboy). When such familiar feelings and habits are abruptly taken away from us, anxiety could set in.  

Adolescents may be in vulnerable phases– they are fascinated with experimenting and romance. Some fall in love with the idea of love and want to be swept away in a whirlwind of movie-like romance, while some fall prey to popular culture that focuses on just having a good time. Either way, mental health should always be given importance. It is easy, especially at this age, for emotions to feel blurry and overwhelming, but being aware of mental health issues that might arise in certain situations could help get intervention and prevention at early stages.

References:

Anxiety after a breakup • r/Anxiety. (n.d.). Retrieved October 24, 2017, from https://www.reddit.com/r/Anxiety/comments/5fecoi/anxiety_after_a_breakup/

End of Relationship Anxiety. (n.d.). Retrieved October 24, 2017, from http://www.therapyinphiladelphia.com/tips/end-of-relationship-anxiety

Gallagher, W. (2001, November 12). Young Love: The Good, the Bad and the Educational. Retrieved October 24, 2017, from http://www.nytimes.com/2001/11/13/health/young-love-the-good-the-bad-and-the-educational.html

Categories
Anxiety and Anxiety Disorders

Taking off the Invisibility Cloak

“We human beings are social beings. We come into the world as the result of others’ actions. We survive here in dependence on others. Whether we like it or not, there is hardly a moment of our lives when we do not benefit from others’ activities. For this reason, it is hardly surprising that most of our happiness arises in the context of our relationships with others.”

Dalai Lama XIV summed up the essential nature of social interactions with this statement. He believes that humans need each other to progress and develop in life, and without co-dependence, it is difficult to further oneself in life. Stronger together, he urged. College is a time where people invest in the future they’ve always dreamed of, it can be a demanding and trying period in a student’s life. The support of fellow students and professors can be key to success, and reaching out for help may make messy situations drastically easier. However, if students are being hindered by anxiety about social interactions, college can become more difficult.

Social anxiety is defined by the DSM-V as the “fear or anxiety about social situations in which the individual is exposed to possible scrutiny by others.” For example, social situations involving a conversation with someone, or meeting an unfamiliar person, or being observed (for example while eating or drinking), and/or performing in front of others, can almost always produce anxiety in people who suffer from social anxiety (DSM-V).  The prevalence of social anxiety on college campuses has increased tremendously, however, have the resources to accommodate this disorder grown parallel (Weaver 2012)? How can a person with social anxiety navigate the plethora of social situations a student can be exposed to, such as: on-campus employment,  group projects, class presentations, attending professor office hours or even writing emails, during their time at college?

An individual’s living condition can either provide stability or break the peace of mind of that individual. For people with social anxiety, a place where they are comfortable is a place where they can escape to after a long day of socializing. This location is crucial for their health. A thread on a website called ‘Social Anxiety Support’ discusses people’s experiences of living in a college dorm could be like. A user called CaptainRoommate said, “I’m sure everyone in my hall thought I was a complete jerk because I didn’t talk to them. Some of the more outgoing people made an effort but I was dismissive. They left me alone most of the time, and the last three years I lived in an apartment.” Another user called Dead Leaves states, “ I lived with three roommates my freshman year of college. I tend to be a pretty open guy, so details about my social anxiety and depression were known to them after a few months. I began to withdraw when I started to worry I was boring them.” These stories share a common theme: avoidance from the fear that they were being negatively evaluated. Negative evaluation is the hallmark of social anxiety– the fear of being rejected, humiliated or even offensive can lead people to withdraw from their social situations (DSM-V). In a post in the HuffPost, Jessica G. gave insight into what goes on inside the head of someone suffering from social anxiety: “I actually find myself talking a lot when I am with my friends… in my mind I’m telling myself, be quiet, you’re talking too much, no one cares, everyone is judging you.

While the residential setup of college campuses can be distressing for people who suffer from social anxiety, achieving the academic expectations in a social environment can also be extremely challenging. ‘Social Anxiety Support’ discusses a user named SArainadash’s academic struggle: “I get tense when a class is about to start. I’m too anxious to eat in the dining halls. I haven’t made a single friend. I looked through every of my college classes’ syllabus, there is just no way I can cope with all those presentations, interviews, speeches, etc. My biggest nightmare right now is not being able to drop out… I know it sounds crazy but I just can’t do these things without shaking in embarrassment. I do not want to attend college until my social anxiety subsides.” A user named ‘gthopia94’ responded to him saying, “I barely made it through 2 months of college a couple of years ago. Don’t even know why I even bothered in the first place.” The narration of such incidents brings to light that surely, dropping out cannot be the only solution for people who suffer from social anxiety in college. Between facing extreme discomfort and dropping out there must be a middle ground, an area of compromise where they can receive accommodations for their comfortability.  A 10-year summary report done by the Center for Collegiate Mental Health in 2015 showed that the overall growth in enrollment at universities was responsible for an increased usage of psychological counseling services, and the rise in demand for such services outpace that of enrollment growth by five times as much, thus making them available to fewer people (Kwai 2016).

While more effort to increase psychological counseling facilities on college campuses is imperative, perhaps an action for bigger change is also appropriate and necessary for all people who have to silently struggle with social anxiety. In 2015, the Equal Employment Opportunities Commission defined the “ability to interact with others” as a major life activity, bringing social anxiety disorder under the protection afforded by the Americans with Disabilities Act (ADA) (Cubbage 2015). While the world is growing and developing exponentially, and all of us are running our rat races, it is important to look back and ensure that we’re providing support and equal opportunities to everyone. Social anxiety affects 7 to 13 percent of the population on the western hemisphere, depending on the diagnostic threshold (Furmark, 2002). Having the ability to access resources provided by the Americans with Disabilities Act (ADA) is one step towards making college a less stressful experience, but we can surely do more to accommodate the needs of those with social anxiety.

References:

Anxiety Disorders. (n.d.). Retrieved October 06, 2017, from http://dsm.psychiatryonline.org/doi/full/10.1176/appi.books.9780890425596.dsm05

Contributed by EmpowHER writer Rheyanne Weaver. (2013, November 16). Social Anxiety Can Be a Hidden Problem in College. Retrieved October 06, 2017, from https://www.goodtherapy.org/blog/social-anxiety-college-students-0717126

College Kids: How’d You Survive Dorm Life?? (1969, December 31). Retrieved October 06, 2017, from http://www.socialanxietysupport.com/forum/f26/college-kids-how-d-you-survive-dorm-life-139302/

Mighty, T. (2017, September 19). 24 Things People Don’t Realize You’re Doing Because Of Your Social Anxiety. Retrieved October 06, 2017, from http://www.huffingtonpost.com/entry/24-things-people-dont-realize-youre-doing-because_us_59b2cfdde4b0c50640cd66e0

College big problem. (2017, March 10). Retrieved October 06, 2017, from http://www.socialanxietysupport.com/forum/f289/college-big-problem-2067425/

Anxiety over Reasonable Accommodation under the ADA for Social Anxiety Disorder. (n.d.). Retrieved October 06, 2017, from https://www.natlawreview.com/article/anxiety-over-reasonable-accommodation-under-ada-social-anxiety-disorder

Furmark, T. (2002, April 04). Social phobia: overview of community surveys. Retrieved October 06, 2017, from http://onlinelibrary.wiley.com/doi/10.1034/j.1600-0447.2002.1r103.x/full

Categories
Anxiety and Anxiety Disorders

Ensuring the Best for Your Baby by Putting Yourself First

The nine months of pregnancy are romanticized as the happiest and most blissful period in a woman’s life. It marks the birth of another soul and the transformation of a woman into a mother: where she learns to put her baby before herself, always. These nine months are spent planning every detail of the baby. Knowing that as a parent, you have the power to create and shape another human can be scary and beautiful in equal parts.

Due to the high stakes involved in this nine-month period, pre-existing anxiety disorders are prone to exacerbation (Rubinchik, 2005). There are psychological and physiological changes happening in the mother-to-be’s life such as increased heart rate, increased blood flow and increased activity in the kidneys may be some (Brown). According to DSM-V, anxiety is defined as the “anticipation of future threat” or “cautious or avoidant behaviors to avoid future danger” During a stressful period such as pregnancy, new mothers can develop protective instincts and worry about providing for their child, thus stress and caution running high. In addition, there are 100 to 1000-fold hormonal variations occurring, which may also exacerbate such emotional difficulties (Rubinchik, 2005). This brings us to a pertinent question: How do mothers deal with anxiety disorders during pregnancy, which is supposedly the epitome of womanhood?

Everything the mother experiences, within herself and her surroundings, affects the fetus (Murphy, 2011) . Hence parents-to-be tend to be extremely careful of what they are exposed to, particularly medication. Everything the mother consumes is absorbed into her blood, and that blood goes into the fetus (Children’s Hospital of Philadelphia). Thus many clinicians admit that they prefer not to prescribe pregnant women medications during these prime nine months. Although there’s no definite information about the effect of anti-anxiety drugs on a fetus, women affected with anxiety do not have access to medication. There are very few studies on expecting women (What to Expect, 2015); Dr. Stephanie Ho, a reproductive psychiatrist, states that FDA’s warning on the SSRI paroxetine (Paxil) risk of increasing cardiovascular defects in a fetus was based on three unpublished studies. This insufficient amount of researched data has caused most women to discontinue their medication for the safety of their child, thus disrupting the blissful period that they are supposed to have during her pregnancy.

On ‘BabyCenter Community’ many women discuss whether taking anxiety medication would be safe for their babies. A user said: “When I was pregnant my doctor stopped my medication and I relapsed. My panic attacks, that had once been under control, were now worse than ever. I developed a new fear of leaving my house and began to feel like a prisoner in my own home. I couldn’t drive either. What bothered me the most though is that there were meds to treat this but my obstetrician thought it was best for me to stay away from them.” Another user said, “I started having panic attacks when I was 11 years old. I am 24 years old now and 19 weeks pregnant. I started suffering from panic attacks again probably after the first trimester. I have one almost every time I leave my house. I talked to my care provider about this and she suggested I stay at home and limit what I do. She said, “I know that doesn’t sound fun, but if it can keep you off meds then do it.” However, she did mention that she would prescribe me meds if my panic attacks did not get any better. I want to be able to do normal things without freaking out so I know I need to get on something. I went so many years without a panic attack and now that I’m pregnant it’s triggering them again. Good luck to you all! I wouldn’t wish panic attacks on anyone.”

Discontinuing medication or not having resources available during a pregnancy can be extremely emotionally taxing for the mother and those around her. Most of the mothers on this “Baby Center Community”  wish that they could continue taking their medication: pregnancy without panic attacks can be exhausting in itself. Constraints like not being able to step out of your house along with additional mental difficulties may leave the mother with unpleasant memories, and perhaps even less willing to bear another child. A mother’s physical health has always been given utmost importance during her pregnancy, such as yoga and nutrition. Adequate research has been done about the physical needs of mothers and the baby’s, however, not enough research has been done regarding medications that are safe to use while pregnant.

On 13 September 2017, Dr. Yonkers at Yale University released the results of a study about the true implications of benzodiazepines and serotonin reuptake inhibitors, which are common medications for Generalized Anxiety Disorder and panic disorder, on pregnant women and their babies. The study recruited women at 137 obstetric practices in Connecticut and Massachusetts before 17 weeks of pregnancy, reassessed them at 28 (±4) weeks of pregnancy, and at 8 (±4) weeks postpartum. The diagnoses of anxiety disorders were determined by the World Mental Health Composite International Diagnostic Interview and other information such as treatment with medications, substance use, previous adverse birth outcomes, and demographic factors were also assessed (Yonkers, 2017).

Dr. Yonkers’ study concluded that with maternal benzodiazepine treatment, 61 out of 1000 newborn babies required ventilatory support and the duration of gestation was shortened by only 3.6 days. On the other hand, mothers who used serotonin reuptake inhibitor to treat their anxiety disorder, gestation was shortened by 1.8 days and 152 of 1000 additional newborns required minor respiratory interventions. What this means is that although there was an increase in some adverse effects, the rates were very modest. It is up to the parents and doctors to decide if continuation of these medications is the best option for the pregnancy, but this study opened an avenue for pregnant women by empowering them with the knowledge of consequences and allowing them to make a more informed rather than cautionary decision.

Every expecting parent’s primary concern is to give their child the very best. To do so, it is vital for them to ensure their own well-being, both mental and physical. Based on Dr. Yonkers’ study, expecting females who struggle with anxiety disorders can consider staying on or starting anxiety medication such as serotonin reuptake inhibitor and benzodiazepines, after consulting their physician, because if they are mentally healthy and eased, their baby gets a healthier mother. Hence, mothers: by putting yourself first you’re actually putting your babies first.

References:

Mom Answers. (2010, February 06). Retrieved September 20, 2017, from https://www.babycenter.com/400_can-pregnancy-bring-on-anxiety-attacks-is-it-safe-to-take-an_2460541_633.bc

Paul, A. M. (n.d.). What we learn before we’re born. Retrieved September 24, 2017, from https://www.ted.com/talks/annie_murphy_paul_what_we_learn_before_we_re_born

Philadelphia, T. C. (2014, August 23). Blood Circulation in the Fetus and Newborn. Retrieved September 24, 2017, from http://www.chop.edu/conditions-diseases/blood-circulation-fetus-and-newborn

Physical Changes During Pregnancy – Women’s Health Issues. (n.d.). Retrieved September 24, 2017, from http://www.merckmanuals.com/home/women-s-health-issues/normal-pregnancy/physical-changes-during-pregnancy

Rubinchik, S. M., Kablinger, A. S., & Gardner, J. S. (2005). Medications for Panic Disorder and Generalized Anxiety Disorder During Pregnancy. Primary Care Companion to The Journal of Clinical Psychiatry, 7(3), 100–105.

(2015, May 28). Anxiety During Pregnancy: What’s Normal and What’s Not? Retrieved September 20, 2017, from https://www.whattoexpect.com/pregnancy/anxiety/

Yonkers, K. A., Gilstad-Hayden, K., Forray, A., & Lipkind, H. S. (2017). Association of Panic Disorder, Generalized Anxiety Disorder, and Benzodiazepine Treatment During Pregnancy With Risk of Adverse Birth Outcomes. JAMA Psychiatry. doi:10.1001/jamapsychiatry.2017.2733