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
Down Syndrome

False Images: A Case of Down Syndrome and Mental Illness

Small chin. Slanted eyes. A tender and pleasant smile. When you type “down syndrome (DS)” into any search engine, these are the first images you see. You find yourself engrossed in photos of jovial men, women, and children. These images etch the impression that those with down syndrome are carefree, innocent, and cheerful in our minds. Very few photos will portray any negative emotions such as anger, sadness, or guilt. Some may even be surprised to found out these cheerful faces plastered in photos, may have mental illnesses.

The National Down Syndrome Society reports that approximately half of those who possess DS face a mental health issue throughout their lifetime. The most common issues include generalized anxiety disorder, obsessive-compulsive disorder, sleep-related difficulties, and depression, among many others. People with down syndrome who possess severe limitations in terms of language and communication skills may find it difficult to articulate their feelings. This increases the difficulty of diagnosing and identifying mental illness in those with DS.

A metacognitive study analyzing over 390 articles concerning depression and down syndrome states several risk factors that are associated with those born with DS. A study of the general population has shown that those with a smaller total brain volume are more likely to develop depression. The same results were found with those who have lower IQ scores (Walker et. al,  2011).

Diane Levine has a son named Cooper, who has down syndrome has always had the illness define who he is. During a conversation with friends discussing their children, one of them will say something along the lines of,  “My neighbor has a little Down’s boy. They’re such angels, aren’t they?” or I love children with Down Syndrome. They’re like gentle lambs (Levine, 2017).” The picture of people with DS being gentle and delightful is not always the case. People with DS have a range of personalities and emotions; just like those without DS. Levine reiterates “I don’t want Down syndrome to define him — except it does, in many ways.”

The image that we have of those who possess down syndrome is a bright and infectiously happy face. However, this falsely paints people with DS as being free of worries or problems. It is important to acknowledge that people with DS are susceptible to mental illnesses just like those without DS.

References:

American Psychiatric Association. (2013). Diagnostic and statistical manual of mental disorders (5th ed.). Arlington, VA: American Psychiatric Publishing.

Levine, D. (2017, April 28). My Son With Down Syndrome Does Not Fit Your Stereotype. https://themighty.com/2017/04/my-son-with-down-syndrome-does-not-fit-your-stereotype/

Munir, K. (2018). Mental Health Issues & Down Syndrome. https://www.ndss.org/resources/mental-health-issues-syndrome/

Walker, J. C., Dosen, A., Buitelaar, J. K., & Janzing, J. E. (2011). Depression in Down Syndrome: A Review of the Literature. Research In Developmental Disabilities: A Multidisciplinary Journal, 32(5), 1432-1440.

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

Categories
Anxiety and Anxiety Disorders

Take A Breath

One of the 10 most influential therapists of the past quarter-century, John Gottman, states, “Empathy and understanding must precede advice.” Oftentimes, when people share their dilemmas, we try to give them quick-fixes and solutions when instead they are searching for compassion and empathy; we present them with solutions thinking we are helping them, when we may be giving them incorrect information. What seems like conventional wisdom could be scientifically incorrect, even when given with the best intentions. People look for understanding and caring, as Gottman suggests.

A generally underrated condition, ‘panic attack’ is a term that is thrown around loosely to describe a feeling of panic and distress a person experiences when something happens unexpectedly. We frequently hear people say, ‘If I forget to take my homework to class tomorrow I’ll have a panic attack,’ or, ‘If my favorite T-shirt shrinks I’ll have a panic attack.’ While these situations may be extremely distressing for some of us or even cause panic attacks, it eludes the true meaning of what a real panic attack may feel like.

Undervaluing panic attacks might prevent us from empathizing with people who actually suffer from them. A panic attack, as described by DSM-V, is an “abrupt surge of intense fear or intense discomfort,” accompanied by at least 4 of a given list of physical symptoms of which include accelerated heart rate, sweating, trembling, and sensations of shortness of breath. The Huffington Post attempted to bring to light some corporal aspects of panic attacks through descriptions of its  Facebook and Twitter communities:

“I can’t stand up, I can’t speak. All I feel is an intense amount of pain all over, like something is just squeezing me into this little ball. If it is really bad I can’t breathe, I start to hyperventilate and I throw up.”

“It feels like my throat is being choked. My arms start tingling because I’m breathing shallowly and not getting enough oxygen, which of course panics me more.”

When these panic attacks become recurrent and unexpected, a person may be suffering from a panic disorder.

People with panic disorders are usually tormented by the fear of these attacks repeating, which may wreck their peace of mind and inhibit them from certain activities (Mayo Clinic). Chores they take for granted may be interrupted by panic attacks, impeding their desire and capacity to carry them out. Sarah, a mother of three, described how panic disorder distressed and altered her life: “One day I was standing in a queue at the bank with a friend and suddenly everything went hazy. I can remember my friend shaking me and asking if I was okay. I felt like something was really wrong, I just needed to get home. My friend was crying with fear. That was my biggest mistake, as the only place I felt safe than was home and it became my prison for 5 years. I was forced by my family to seek medical help and my [general practitioner] made me feel I was overreacting. Asking for help every time I needed shopping was degrading. The worst day of my life came when my daughter fell and broke her wrist and she was terrified and crying and I had to watch her being taken to hospital by someone else as the panic had too big [a] hold on me.”

Panic attacks may affect people mentally, physically, or emotionally. Understanding, love, and care can make them feel like they have space to heal and someone to heal for. Sarah’s personal experience coincides with this:

“There is also nothing like the feeling of watching friends and family go on holiday and knowing I couldn’t take my children anywhere. My eldest son couldn’t bare to see me suffering and moved out at 16 to live with his girlfriend, but my other two children never once asked anything of me. We spent many hours having great times at home, playing games and watching movies. They were the reason I was determined to recover.”

It may not always be obvious when someone is experiencing a panic attack, but if they do share with you, you may be inclined to assist them in some way. It is crucial that legitimate guidance be given. About 6 million people suffer from panic disorder in America (ADAA), the majority of whom experience hyperventilation during their attacks. According to Mark Tyrrell, a therapist trainer for 15 years, 60% of panic attacks are accompanied by hyperventilation. Literally translating to ‘over-breathing’, they could be a cause or an effect of panic attacks. When it occurs, the person enduring it may feel like they are short of breath because there isn’t enough oxygen in the body. However, the contrary is true– hyperventilation is a symptom of too much oxygen in the body (Tyrell).

Panicking people are often told to “calm down” and “take deep breaths,” but for someone hyperventilating during a panic attack deep breathing is a bad idea. Symptoms like dizziness and numbness occur, making the person feel like they’re suffocating; thus “taking deep breathes” would further exacerbate the problem by increasing the oxygen in the body (Meuret). A new form of therapy called capnometry-assisted respiratory training (CART) therapy teaches patients to take shallow breaths and has been found efficient in assuaging panic symptoms. Thus, the fitting action in such a situation would be to take quick, shallow breaths to balance the carbon dioxide and oxygen contents in the body.

Panic disorder can be overwhelming and debilitating for the person who suffers from it. While adopting new breathing techniques and finding the right therapy style is essential, those with panic disorders need tenderness and support of family and friends in order to heal.

References:

Holmes, L. (2014, October 21). This Is What A Panic Attack Physically Feels Like. Retrieved April 30, 2017, from http://www.huffingtonpost.com/2014/10/21/panic-attack-feeling_n_5977998.html

Chapter 16. Panic Disorder. (n.d.). Retrieved April 30, 2017, from http://psychiatryonline.org/doi/full/10.1176/appi.books.9781585625048.gg16

Pappas, S. (2010, December 26). To Stave Off Panic, Don’t Take a Deep Breath. Retrieved April 30, 2017, from http://www.livescience.com/9204-stave-panic-deep-breath.html

Part 4: Panic attack symptoms – Hyperventilation (over-breathing). (n.d.). Retrieved April 30, 2017, from http://www.panic-attacks.co.uk/course/4-panic-attack-symptoms-hyperventilation-over-breathing/

Panic attacks and panic disorder. (2015, May 19). Retrieved April 30, 2017, from http://www.mayoclinic.org/diseases-conditions/panic-attacks/basics/definition/con-20020825

Sarah’s Anxiety Story. (2014, October 01). Retrieved April 30, 2017, from https://www.nopanic.org.uk/sarahs-anxiety-story/

Facts & Statistics. (n.d.). Retrieved April 30, 2017, from https://www.adaa.org/about-adaa/press-room/facts-statistics

Categories
Anxiety and Anxiety Disorders

“Just Breathe”

This article is based on the narrative of a college student coming to terms with their anxiety disorder. Recently diagnosed, the student discusses the impact their illness has had on their everyday life and communicating their disorder with others.

When the onset of my anxiety disorder kicked in, I didn’t know what was happening. In my head, I was always prone to stressing out and over-thinking things. I accepted it as part of my personality. I accepted that I was always on the edge. Always worried about things I couldn’t change; past, present, and future. I always worried about my future.

When life started to pick up, so did my anxiety.

I began experiencing little attacks when I found myself especially stressed; a shortness of breath and difficulty breathing. Chest pains that would worsen the tighter I held myself. My heart felt like it was going 100 miles a minute. My palms would get clammy, and all I could do is try to hold it together.

Waiting. Waiting. Waiting.

I would do my best to get my breathing in control, but more often than not; I let it run its course.

A panic attack is an abrupt surge of intense fear or intense discomfort that reaches a peak within minutes, and during which time four or more of a list of 13 physical and cognitive symptoms occur. The term recurrent literally means more than one unexpected panic attack. The symptoms of a panic disorder are similar to that of heart disease, thyroid problems, breathing disorders, and other illnesses and therefore often those with panic disorders will make trips to the emergency department or doctor’s office.

More often than not, the attacks would occur in public. I would be sitting at lunch, with friends, or even walking to classes. It just seemed that one thought led to another and slowly I would become consumed by my thoughts. More often than not, I didn’t see these little attacks coming. I assumed my stress would subside, or I would find a way to distract myself in order to distance myself from whatever thought filled every corner of my mind.

The term unexpected refers to a panic attack appears “out of the blue,” where there is no obvious cue or trigger at the time of occurrence. Such as when the individual is relaxing or emerging from sleep (nocturnal panic attack). In contrast, expected panic attacks are attacks for which there is an obvious cue or trigger, such as a situation in which panic attacks typically occur. A clinician will determine whether the panic attacks are expected or unexpected. Clinicians will make the call based on a combination of careful questioning as to the sequence of events preceding or leading up to the attack and the individual’s own judgment of whether or not the attack seemed to occur for no apparent reason. 

Every aspect of my life seemed to be dictated by my anxiety, and worrying about the next potential panic attack did nothing to ease my concerns. School became more difficult; my attendance in my earlier classes began to suffer if I managed to fall asleep; I would often be so exhausted in the morning that I could not bring myself to get out of bed. The exhaustion would build, but so would the workload. I found that even though I felt stuck in where I was, whatever moment I was obsessing over, that the world around me kept moving forward. I felt I couldn’t move forward. I didn’t want to meet with my professors to discuss what was going on because I had no idea. In my head, the conversation explaining my stress and lack of sleep seemed typical of the college student experience and nothing that would provoke any sort of understanding from Professors. The phrase “everyone gets stressed, everyone freaks out” repeated over and over in my head. I worried what I was going through was not going to warrant understanding, especially from my older professors.

Anxiety and panic disorders are often glossed over as mental illnesses. Often times, people will hide their panic disorders, worries that they’ll be seen as a hypochondriac rather than someone with a real, and very treatable disorder.

The degree of anxiety I began experiencing over the past year and a half had grown to almost weekly panic attacks. I was worried that if I told professors, that I was going to be told to manage my time better, and change my eating/exercise habits as a means of combatting my stress, rather than understanding the severity of a diagnosis.

For those with Generalized-Anxiety Disorder, anything can cause worry. Individuals will display excessive anxiety or worry for months and face several anxiety-related symptoms, such as restlessness, difficulty concentrating, and sleep problems. Though occasional anxiety is a normal part of life, anxiety disorders involve more chronic anxiety. This impacts the everyday life and can get worse over time if not properly addressed and treated

References:

Anxiety Disorders. (2016, March). Retrieved from https://www.nimh.nih.gov/health/topics/anxiety-disorders/index.shtml

Black, D. W., & Grant, J. E. (2014). DSM-5 TM guidebook the essential companion to the Diagnostic and statistical manual of mental disorders, fifth edition. Washington, DC: American Psychiatric Publishing.

Generalized Anxiety Disorder. (2017, March 29). Retrieved from https://www.psychologytoday.com/conditions/generalized-anxiety-disorder

Categories
Anxiety and Anxiety Disorders Depression

Unknown Treatment: The Lack of Awareness about CBT

According to the DSM-V (2013), anxiety disorders refer to any disorders in which the diagnosed person experiences “excessive fear and anxiety and related behavioral disturbances,” and the varying disorders differ from one another depending upon what causes this fear or anxiety in the individual (p. 189).  A great number of studies have shown that the most effective method of treatment for these disorders is exposure-based treatment, either on its own or as part of cognitive behavioral therapy (CBT), through which the sufferer is slowly brought into contact with what he or she is afraid of (Wolitzky-Taylor, Zimmermann, Arch, De Guzman, & Lagomasino, 2015).  Not only have we seen the effects of exposure-based therapy in efficacy studies and clinical studies, but when comparing it to SSRI medication and psychotherapy as treatments for anxiety disorders, exposure-based CBT has proven to be the most superior form of treatment (Wolitzky-Taylor, Zimmermann, Arch, De Guzman, & Lagomasino, 2015).

“Only up to 11% of adults with anxiety disorders receive the kind of treatment they should be getting”

More surprising though is the finding that most adults in the United States haven’t even heard of this type of treatment, and furthermore only up to 11% of adults with anxiety disorders receive the kind of treatment they should be getting.  These adults don’t know about exposure-based CBT, and as a result end up spending more on costly pharmacological treatments instead, even though a psychosocial treatment like exposure-based CBT would prove to be the most cost-effective route to take (Wolitzky-Taylor, Zimmermann, Arch, De Guzman, & Lagomasino, 2015).  Just as well, in all studies thus far that have taught adults about various anxiety disorder treatments, there has consistently been a majority whom have expressed preference toward exposure-based psychosocial approaches rather than pharmacological approaches, further reinforcing the need to spread information about the effectiveness, in terms of both cost and outcome, of exposure-based cognitive behavioral therapy (Wolitzky-Taylor, Zimmermann, Arch, De Guzman, & Lagomasino, 2015).  What we see here then is that most adults in the United States who are receiving treatments for anxiety disorders are undergoing treatments which have proved less effective than others because these people haven’t learned about anything that would work better for them in regards to money and outcome.

Wolitzky-Taylor and colleagues looked at the electronic medical records at the Los Angeles Adult Outpatient Psychiatry Clinic over the span of six months in order to see just how much exposure-based CBT was used as treatment for people with anxiety disorders who have low incomes and go to a large community mental health center (2015).  This facility was chosen because it reflected other clinics like it due to its urban location and its patient diversity, though it may have more professionals trained in CBT than the average community clinic since about 75% of the staff has had basic CBT training and supervision before. But even in a clinic with an unusually high number of clinicians trained in cognitive behavioral therapy, less than 4% of all 582 patients diagnosed with anxiety disorders in that six-month period received one session or more of exposure-based treatments (Wolitzky-Taylor, Zimmermann, Arch, De Guzman, & Lagomasino, 2015).  Despite being present in a setting where CBT training was found to be more prevalent than in most other community clinics, it was still only a minority of patients who were receiving this type of treatment—we can understand from this that the average clinic is thus providing even less cognitive behavioral therapy to other patients nationally.

For the approximate 4% of the total patients in the Los Angeles County AOPC receiving treatment for anxiety disorders, those who did get exposure-based CBT were not receiving a dose that would be enough to help treat their disorders, meaning that they were not attending as many sessions as recommended based on past studies conducted (Wolitzky-Taylor, Zimmermann, Arch, De Guzman, & Lagomasino, 2015).  Since patients aren’t going to the recommended amount of sessions, which would be between ten and sixteen of them, the clinicians need to work out a plan for each patient that would best utilize the amount of time that he or she does have in order to get optimal results.

The researchers found that, in regards to the total 582 patients receiving treatment for anxiety disorders, almost 90% of the patients were offered pharmacological treatment for their anxiety disorder, and that almost 90% of those accepted this treatment.  Just as well, almost 70% of the patients were offered a non-CBT type of psychotherapy, and almost all of these patients accepted that treatment.  These treatments are less effective than exposure-based cognitive behavioral therapy, in terms of both cost and outcome, and patients with anxiety disorder are neither being presented with the option of receiving CBT nor bringing up the option themselves.  Information about this type of treatment for anxiety disorders needs to be better distributed amongst adults with anxiety disorders so that they can get the right kind of treatment and get on the best track toward improved health.

References:

Wolitzky-Taylor, K., Zimmermann, M., Arch, J. J., De Guzman, & E., Lagomasino, I. (2015). Has evidence-based psychosocial treatment for anxiety disorders permeated usual care in community mental health settings? Behaviour Research and Therapy, 72, 9-17.

Categories
Depression

Anxiety and Its Impact on College Campuses

By: Yasharah Raza

Are you a college student? Do you spend a lot of time on a campus? If so, chances are you’ve seen the stressed visages that are so characteristic of college students. Many college students across the United States have a healthy balance of stress, anxiety, and free time in their lives; however many more suffer from anxiety disorders that have a great impact on their physical and mental health and overall well-being.

The first onset of an anxiety disorder often occurs in college. In fact, 30 million adults in the United States suffering from an anxiety disorder experienced their first occurrence by age 22 (ADAA, 2015). On top of that, over 40 million adults suffer from anxiety disorders each year (ADAA, 2015). There is a wide range of anxiety disorders that can specifically affect college students, including—but not limited to—Panic Disorder, Social Anxiety Disorder, and General Anxiety Disorder (MHAI, 2007).

Why are there so many people, especially college students, who suffer from anxiety? Entering college is a highly transitory period for almost every student. “Students experience many firsts, including new lifestyle, friends, roommates, exposure to new cultures and alternate ways of thinking,” said Hilary Silver, a licensed clinical social worker (Psych Central, 2015). All of these new elements of life, combined with the increase in academic competitiveness across college campuses can have a profound impact on students, especially those who may have already been struggling with a mental disorder in high school or even earlier (Psych Central, 2015).

Because students often fear suffering from the perceived social stigma attached to being diagnosed with a mental disorder such as anxiety, many students fail to receive the help that they need. Often times, the people surrounding the student may not even be aware that he or she may be suffering from an anxiety disorder (Psych Central, 2015). It is vital that people who may be struggling take advantage of resources available to college students, such as hotlines and local counseling centers. Anxiety disorders may be rampant across college campuses, but that doesn’t mean that one has to go untreated. If treated properly, college students will find that anxiety disorders need not affect them as much as they perceive it to.

References:

Anxiety and Depression Association of America. (2015). Facts. Retrieved February 15, 2015, from: http://www.adaa.org/finding-help/helping-others/college-students/facts

Mental Health America of Illinois. (2007). Healthy Minds: Tips for Every College Student. Retrieved February 15, 2015, from: http://www.mhai.org/College_Students.pdf

Psych Central. (2015). Depression and Anxiety among College Students. Retrieved February 15, 2015, from: http://psychcentral.com/lib/depression-and-anxiety-among-college-students/0001425