Panic and Anxiety Disorders

A lump in your throat before you give a presentation at work or the nervousness you feel as you slowly inch up the hill of a 400 ft tall roller coaster are normal stress and anxiety responses that arise as needed throughout life. Some anxiety is good for us; it keeps us on our toes and helps us stay safe. When these feelings linger for longer than usual, however, or you find yourself feeling a pervasive sense of impending doom that arises out of nowhere for no reason, you may be experiencing symptoms of Generalized Anxiety Disorder (GAD). GAD can have a far-reaching impact on a person’s livelihood—making day-to-day tasks seem daunting and causing issues with work, family, friends, school, and personal self-worth.

If this sounds like something you or a loved one are going through, you are not alone. Generalized anxiety disorder affects 5.7% of adults in the U.S. at one point in their lives, and this is only based on the number of people who have been diagnosed. Of those who have been diagnosed with generalized anxiety disorder, a significant percentage do not seek treatment to manage their symptoms. While there is no one-size-fits-all cure that works for everyone with GAD, there are a variety of treatment options available to help with the symptoms and make life more manageable.

Generalized anxiety disorder (GAD) is the most common form of anxiety. This condition causes excessive worry over everyday events. These feelings are oftentimes disproportionate to the situation at hand and can become uncontrollable. These thoughts and feelings can make it difficult for a person to concentrate. GAD tends to develop slowly, beginning in the adolescent to young adult years.

As anxiety increases over time, so does its impact on a person’s ability to function in life. Anxiety at its worst can be debilitating, and panic attacks may result. Once someone experiences a panic attack, it is possible to suffer from anxiety surrounding the fear of having another one. This can cause one to refrain from venturing to public places and situations of high stress.

With GAD, there is often a pattern of pessimistic thoughts and physical sensations (stress responses) that are at play throughout the day—obsessing over the worst-case-scenario of every situation. The more stressful the situation (such as one’s job and financial security), the more pervasive and worrisome the dialogue can be.

The areas of day-to-day life that most plague the thoughts of a person with GAD include:

A person with GAD may find oneself in a fictitious argument with a boss or colleague—arguing with a made-up voice expressing one's present fears. This can happen while thinking about a worst-case-scenario situation that may or may not happen at the next company meeting. These negative, worrisome ways of thinking and feeling work against a person’s efforts to not only survive this life, but to thrive in it.

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Anxiety Cycle

While each case of GAD is unique and symptoms present differently from one individual to the next, those most commonly associated with GAD include:

Excessive worry in the absence of a clear and present threat;
Feeling worried more often than feeling calm, centered, or at peace;
The focus of worry can be difficult to control and may change from one topic to the next.

These symptoms have been present for six months or longer, and are accompanied by at least three of the following:

• Restless
• Irritability
• Concentration difficulties
• Difficulty falling asleep and/or staying asleep
• Fatigue
• Muscle soreness and joint aches

• Changes in eating habits
• An inability to relax or remain calm and centered
• Difficult swallowing
• Headaches and stomach aches
• Irregular bowel movements
• Lightheadedness
• Sweating
• Feeling out of breath
• A nervous twitch
• Panic attacks

Anxiety disorders oftentimes occur alongside a variety of additional conditions such as depression, Post-Traumatic Stress Disorder (PTSD), substance use disorder, etc.

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Anxiety Symptoms

The root cause of anxiety differs from one unique individual to the next. There is no one-size-fits-all root cause for each and every case of anxiety, and if there is, researchers have yet to discover it.

Our genetics come into play when it comes to our level of resilience and susceptibility to developing a mental health disorder. Our DNA does not predetermine whether or not we will develop such a disorder, but once triggered by a chemical imbalance or a traumatic event, genetics hold the power to tip the scales.

Research shows us that the ways we learn to respond to stress, process our emotions, and cope with stressful situations by the time we are teens influence the likelihood of developing a mental health disorder, such as GAD, later on in life. This is especially true for those who grow up in high-stress or high-conflict environments.

Trauma is an incident that causes physical, emotional or life-threatening harm. Witnessing a traumatic event or being in a situation where ones safety is at risk can cause trauma. There are many types of events that can cause trauma; including threats made by someone you know or by a stranger or a natural disaster. Everyone responds to trauma differently. Being able to process the traumatic event with a trusted therapist is the best defense against developing an adverse reaction that could last for months or years.

Our brains contain chemicals called neurotransmitters that account for a variety of functions from our mood and feelings of pleasure, to learning and concentration. When these chemicals are out of balance, it can cause us to experience symptoms of anxiety and depression.

Dopamine and serotonin are two neurotransmitters that play an integral role in our mental health. They can become imbalanced when we do not get enough sleep, if we deplete these chemicals from the use of drugs, and when we aren’t taking care of ourselves as we should by getting the nutrients, exercise, and sunshine that we need. Diet is another important factor, as we have more neurotransmitters located in our gut (our gastrointestinal system) than in our brains.

Generalized anxiety disorder is a treatable condition. As mentioned earlier, there is no one-size-fits-all treatment option that works for everyone. Each unique individual responds to treatment differently, and so it may take some time to find the combination of options that works best for each person at the start of treatment.

There are a variety of therapy options available for those who suffer from GAD. Some of the most common forms of therapy that have been used to treat GAD include:

• Cognitive-Behavioral Therapy (CBT)
• Eye Movement Desensitization and Reprocessing (EMDR)
• Trauma-Focused Cognitive-Behavioral Therapy (TF-CBT)
• Dialectical Behavioral Therapy (DBT)

EMDR involves eye movement desensitization. EMDR is accomplished through therapy sessions with a certified EMDR therapist. This does not involve talking through the traumatic event, but moving your eyes at the guidance of the therapist while remembering the event. This is done to activate the hippocampus and timestamp the traumatic memory so that it can be successfully stored, and in turn, less powerful. The hippocampus is located in the middle, inner part of the brain and helps to regulate emotions (Encyclopedia Britannica, May 2023). This form of therapy is effective in treating trauma with fewer sessions required than other methods of treatment, including CBT. You can read more about EMDR here.

TF-CBT is designed for working with families who have experienced trauma. The goal of this therapy model is to bring families together so they may cope with the aftermath as a family—strengthening its bonds, building trust, and coping skills while improving communication. You can read more about CBT here.

DBT is a form of therapy that is rooted in CBT and designed to help clients achieve emotional regulation and balance in life through individual and group therapy sessions designed to help manage emotions, change behavioral patterns, and form healthy coping skills. DBT typically lasts six months, although this can vary from one individual to the next. You can read more about DBT here.

Antidepressants are typically a first line of defense in treating symptoms of anxiety with pharmaceuticals. This is usually done with a selective serotonin reuptake inhibitor (SSRI), like Prozac, Paxil or Zoloft, also used to treat major depression. It is important to note that SSRIs are not effective in treating every case of anxiety. Some sources report as many as 50% of individuals do not respond to these medications.

Benzodiazepines (such as Xanax, Valium, etc.) may also be used to treat episodes of extreme anxiety or panic. It is important to use these medications minimally as a daily treatment method as they are physically addictive, and the withdrawals can be fatal. You can read more about medications here.

• Selective serotonin reuptake inhibitors (SSRIs) and serotonin-norepinephrine reuptake inhibitors (SNRIs). Fluoxetine (also known as Prozac), paroxetine (also known as Paxil or Seroxat), and sertraline (also known as Zoloft) are examples of SSRIs, and venlafaxine (also known as Effexor) is an example of an SNRI. These drugs work by enhancing the activity of the chemical serotonin within the brain. These higher levels of serotonin activity are associated with a reduction of symptoms of anxiety.
• Beta-blockers. Beta blockers can help to reduce the physical symptoms of panic disorder and are often used to prevent panic attacks in situations where panic attacks are anticipated. These drugs are prescribed for panic disorder less frequently than SSRIs and SNRIs.
• Benzodiazepines. These drugs can stop a panic attack quickly once it starts, but they are powerful sedatives that can lead to dependence so are used sparingly to combat issues related to panic disorder.
• Monoamine oxidase inhibitors (MAOIs). Monoamine oxidase inhibitors are a class of drugs that inhibit the activity of one or both monoamine oxidase enzymes: monoamine oxidase A and monoamine oxidase B. These drugs tend to be kept as a last resort for both anxiety and depression because they are associated with serious adverse side effects.

There are a variety of holistic treatment options available for managing GAD symptoms. People have found relief from natural supplements such as GABA, micronutrient supplements, lavender essential oil, lifestyle changes that support a healthy diet and exercise, diaphragmatic breathing, mindfulness, meditation, and more. You can read more about supplements, breathing exercises, mindfulness and meditation here.

Living with GAD can feel like a constant struggle with one’s own mind. It can make a person feel isolated from friends and family and can cause one to worry that he or she will never feel well, whole, happy, or at peace again.

The good news is that this condition is treatable. While it may take some time to figure out the right combination of treatment that works best for each individual, it is well worth it. No one should have to suffer with anxiety alone. Support and help is available for those who need it.

Panic disorder involves recurrent panic attacks that come on suddenly and usually last for several minutes. In severe cases, panic attack symptoms can last more than an hour. The disorder usually develops in early adulthood or slightly earlier and occurs about twice as often in women as in men. Most people suffer at least one or two panic attacks in their lifetime, but those with the disorder experience these attacks much more frequently.

Experts have described panic disorder as a "fear of fear." People with the disorder tend to worry about disasters and about losing control. They also often misinterpret bodily sensations as signals of danger. As a result, upon sensing things like dizziness, chest pain, or shortness of breath, someone with panic disorder may become hypervigilant, exacerbating the bodily sensation, further enhancing their hypervigilance. The anxiety that accompanies this type of experience often sets off a panic attack.

In addition to the suffering that comes from panic attacks themselves, patients with panic disorder are also often limited in their activities because of the psychological burden of anticipating panic attacks. It is common for those with panic disorder to avoid situations in which they think a panic attack may occur, as the dread associated with imagining a panic attack is a major feature of the disorder.

It is common for people experiencing their first panic attack to perceive it as a heart attack.

The symptoms of panic disorder include:

• Overwhelming sense of fear, anxiety or doom
• Feeling out of control
• Irrational fear of death
• Sweating
• Shortness of breath
• Heart pounding
• Shaking
• Chest pain
• Numbness
• Nausea
• Dizziness

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Health Anxiety

It is not clear how or why panic disorder develops, but research has helped to clarify some of the factors that may increase one’s risk for the disorder. These factors include:

• Family history If other people in your family have panic disorder, you are more likely to have the disorder as well. The link between family history and panic disorder is not completely clear, but it likely involves both genetic and environmental elements.
• Stress Panic attacks have been observed in people who are undergoing a major life transition or who are exposed to significant stress, such as the loss of a loved one. Though it is not completely understood how stress may lead to panic disorder, high levels of stress increase the risk for developing the disorder.
• Substance abuse Panic disorder may follow drug or alcohol abuse or withdrawal, as well as excessive caffeine intake.

From a biological perspective, studies in neuroscience and psychology have shown that certain parts of the brain are implicated in panic disorder. A part of the brain called the amygdala has been deemed a critical player in panic disorder. The amygdala processes emotional information, including fear. It, along with other parts of the brain, such as areas known as the hippocampus and prefrontal cortex, make up a fear circuit – or fear network – that is active during panic attacks. Areas of the brain involved in processing sensory information have also been suggested to be part of this fear network, which would help to explain how bodily sensations lead to panic attacks.

Panic disorder is chronic and cannot be cured. However, there are several options that people with the disorder can pursue to reduce their symptoms and hopefully live more comfortably with their condition.

Healthcare providers usually treat panic disorder with psychotherapy, medication, or a combination of the two.

Cognitive-behavioral therapy (CBT) is a first-line treatment for panic disorders. This type of psychotherapy focuses on appealing to the patient’s cognitive abilities to change the way they think and react to feelings that have historically led to their panic attacks. By learning to think and behave differently in response to physical sensations and fear, you can disrupt the brain activity that leads to panic attacks, thereby preventing the attacks.

There are several different drugs that can be used to combat panic disorder and to prevent the attacks that characterize it. These drugs include:

• Selective serotonin reuptake inhibitors (SSRIs) and serotonin- norepinephrine reuptake inhibitors (SNRIs). Fluoxetine (also known as Prozac), paroxetine (also known as Paxil or Seroxat), and sertraline (also known as Zoloft) are examples of SSRIs, and venlafaxine (also known as Effexor) is an example of an SNRI. These drugs work by enhancing the activity of the chemical serotonin within the brain. These higher levels of serotonin activity are associated with a reduction of symptoms of anxiety.
• Beta-blockers. Beta blockers can help to reduce the physical symptoms of panic disorder and are often used to prevent panic attacks in situations where panic attacks are anticipated. These drugs are prescribed for panic disorder less frequently than SSRIs and SNRIs.
• Benzodiazepines. These drugs can stop a panic attack quickly once it starts, but they are powerful sedatives that can lead to dependence so are used sparingly to combat issues related to panic disorder.
• Monoamine oxidase inhibitors (MAOIs). Monoamine oxidase inhibitors are a class of drugs that inhibit the activity of one or both monoamine oxidase enzymes: monoamine oxidase A and monoamine oxidase B. These drugs tend to be kept as a last resort for both anxiety and depression because they are associated with serious adverse side effects.

You can read more about these medications here.

In addition to the medical interventions to fight panic disorder, there are lifestyle changes that are often recommended for those who experience regular panic attacks. These changes include: eating well, minimizing caffeine and alcohol, exercising, getting more sleep, and maintaining a normal routine.

Recurrent and sudden panic attacks are indicative of panic disorder. Though the cause of panic disorder is not well understood, there are several ways to combat the symptoms. These strategies include lifestyle changes, therapy, and medications. These approaches may on their own or in combination help people with panic disorder to reduce their anxiety and enjoy a higher quality of life.

As defined by the Cleveland Clinic, “Separation anxiety disorder is an intense fear of being separated from a loved one or caregiver.” It can affect children and adults. Separation anxiety is a normal emotion in babies and toddlers. When anxiety interferes with age-appropriate behavior, it becomes a disorder that needs to be treated. Treatment can include therapy and medication.

Ever have unwanted thoughts that lead to feeling distressed? While unwanted thoughts and upsetting feelings can be a normal part of the human experience, there are some instances where these intrusive thoughts can become so distressing that a person engages in certain compulsive behaviors to try to eliminate them. This is known as obsessive-compulsive disorder, or OCD.

OCD can start at any age and affects men, women, and children of all backgrounds, ethnicities, and races equally. It is estimated that 1 in 100 adults have the disorder within the United States.

OCD consists of two key elements: the presence of obsessions and compulsions. The obsessions that a person with OCD has are thoughts that occur over and over that feel beyond manageable to the person experiencing them. The thoughts are intrusive to the individual and tend to feel out of control. Many times, people with OCD realize these thoughts are irrational but continue to have them anyways. Examples of obsessions that a person with OCD could experience include a preoccupation with staying clean, fear of contamination, unwanted sexual thoughts, religious-related obsessions, perfectionistic thoughts, and fear of losing control. While this is not an exhaustive list, these obsessions are more common for a person with OCD.

It is important to recognize that while the word obsession gets thrown around often in today’s culture, not just any unwanted thought is considered an obsession. In the casual sense of the word, obsession can mean a preoccupation with something, while an OCD obsession creates problems and internal tensions for the individual in their daily life.

The second component of obsessive compulsive disorder is the presence of compulsions. Compulsions are a response to the uncomfortable nature of obsessions and involve rituals or repetitive behaviors to help ease anxiety. The individual with OCD uses these compulsions with the intention to minimize the uncomfortable thoughts (obsessions) they are having. The important distinction to recognize with compulsions is that they are time-consuming, affect daily life functioning, and get in the way of activities the individual values. These behaviors are a response to the obsessions, a way to reduce the anxiety caused by the intrusive thoughts.

Like obsessions, not all repetitive behaviors are considered compulsions. An OCD compulsion occurs when the individual feels strongly driven to complete the behavior, which gets in the way of functioning normally throughout the day. It is important to be aware of the context around the behavior, recognize what the function is, and identify if the person completing it would rather not be doing it but feels compelled to do so. Some examples of OCD compulsions include washing hands, ordering or arranging, cleaning, checking, or repeating. While this is not an exhaustive list, it highlights many of the common compulsions recognized in OCD.

While OCD is mainly identified through the presence of obsessions and compulsions and their negative impact on daily life, there are some beliefs that can be present for a person with OCD. These dysfunctional beliefs can include:

• Having control over one's thoughts
• Imperfection is unacceptable
• Over importance of thoughts
• Believing they can cause or are responsible for events outside of their control
• Intolerance for uncertainty
• While having these thoughts do not necessarily mean an individual has OCD, they are examples of intrusive thoughts and belief systems that a person with OCD holds that can become detrimental to mental health and daily functioning.

While research has established how chemicals and electrical impulses within the brain affect human behavior, there has been no recognition of a definitive cause for OCD. Some factors that are believed to contribute to OCD include:

• Genetic predisposition – 25% of individuals with OCD have an immediate family member who shares the same disorder
• Behavioral conditioning
• Environmental, such as traumatic brain injuries
• Severe trauma

A study completed by the National Institute of Health (NIH) identified that OCD may be associated with a mutation within the gene that transports serotonin in the brain, showing a likely chemical component to the disorder.

It is important to note that there has been no definitive cause identified for OCD and research is still underway. While no single identifiable cause has been found, it has been identified that the interplay between many factors play a role in the development and continuation of the disorder.

The most common and effective treatment for OCD includes a combination of cognitive behavioral therapy and medication. Exposure and Response Prevention, or ERP, is a type of cognitive behavioral therapy considered most beneficial for individuals struggling with OCD. ERP focuses on confronting obsessions and resisting compulsions. The person is then encouraged by a therapist to tolerate the anxiety and uncomfortable feelings that arise.Combined with a selective serotonin reuptake inhibitor (SSR) medication, ERP is considered first line treatment for OCD.

Exposure and Response Prevention is a type of therapy that is great for individuals with OCD because it focuses on confronting obsessions and resisting compulsions. With ERP, the person is put into an anxiety-triggering situation that would normally lead to acting out the compulsion. Supported by the therapist, the person is encouraged to tolerate the anxiety and uncomfortable feelings that arise.

Other ways to help manage OCD symptoms and find relief include joining a support group, managing stress and anxiety, incorporating relaxation techniques and mindfulness into a daily routine, getting at least 7 hours of sleep each night, and eating a healthy diet.

OCD can be a frustrating and debilitating disorder. Not only does it affect the individual, but it can have lasting impacts on those around them. Individuals may feel lonely and isolated because of the intrusive thoughts and time-consuming compulsions but it is important to recognize that support is available. With the right tools and support, it is possible to manage even the most intense and distressing symptoms of OCD.

Stressful and even traumatic – that is, emotionally or physically disturbing or distressing — events happen in life. After a traumatic event, you may experience a greater level of fear or terror, feel out of control, or think that one or others’ lives are in danger.

Most people who experience a traumatic event may have problems adjusting and coping in the aftermath. With time and self-care, they generally feel better in the long run. However, if your symptoms get worse over time, persist for weeks, months, or even years, and interfere with daily functioning, you may have Post-Traumatic Stress Disorder or PTSD.

PTSD is an anxiety disorder that can develop following a trauma. Trauma exposure in a PTSD diagnosis need not be first-hand; for example, an individual learning about the death of a close family member could develop PTSD, although they were not present at the time the death occurred.

It is unclear why some people get PTSD and some people do not after experiencing trauma.

While the symptoms of PTSD can be debilitating, a variety of management and treatment options are available.

PTSD affects about 8 million Americans at some point over the course of their lives – 10% of women experience PTSD at some point, compared to 5% of men. Traumas can include anything from a serious car accident, to physical or sexual assault or abuse, traumatic events at work, or health problems (such as a cancer diagnosis or being admitted to intensive care). Members of the military who have worked in combat zones are at high risk for PTSD, for example, due to their exposure to the traumas of war. Approximately 11-20% of veterans returning from Iraq or Afghanistan have PTSD.

People who have PTSD may have intrusive memories of the traumatic event. They may avoid thinking or talking about the event or avoid visiting places, activities, or people that remind them of the traumatic event. Those with PTSD may also experience negative changes in thinking and mood, and may be easily startled or feel like they are always looking out for danger.

PTSD can affect relationships with friends, family, and coworkers, and can cause one to lose interest in activities they once enjoyed. Cognitive and sleep problems are also a part of PTSD. In response to these symptoms, those with PTSD may resort to unhealthy coping mechanisms such as alcohol and drug abuse, which can actually make symptoms worse and lead to new problems. That’s why it’s so important to get help dealing with PTSD.

A very severe type of PTSD called complex post-traumatic stress disorder or C-PTSD can develop in response to prolonged, repeated traumatic experiences that may persist or repeat for months or even years. C-PTSD can cause behavioral, emotional, cognitive, and interpersonal problems. It is frequently associated with substance abuse, mood and personality disorders. Traumas that begin in childhood and persist can cause C-PTSD. Examples of events that can trigger C-PTSD include concentration camps or prisoners of war, long-term domestic violence, long-term child physical abuse, and child exploitation.

The good news is that there are many treatments available for PTSD and C-PTSD, that can help patients recover and deal with the trauma to improve day-to-day functioning.

PTSD symptoms can start as soon as one month after a traumatic event, or appear years after the event has occurred. PTSD symptoms can be grouped into four main categories: intrusive thoughts, avoidance, hyperarousal, and negative changes in mood and cognitions.

Those with PTSD may experience recurring, unwanted distressing memories of the traumatic event. They may experience flashbacks in which they are reliving the traumatic event as if it was occurring again. Nightmares and upsetting dreams can be common as well. Reminders of the traumatic event can cause severe emotional distress or physical reactions in an individual with PTSD.

A person with PTSD may avoid thinking or talking about the traumatic event. They may also avoid people, places, activities, or other things that remind them of the event.

Negative thoughts and feelings are a component of PTSD. The individual may hold distorted beliefs about themselves or others; feel fear, horror, anger, guilt, or shame; and have depressive symptoms. For example, the individual may have less interest in activities they once enjoyed, or feel hopeless, sad, or angry. Those with PTSD may also have memory problems, including an inability to remember important details of the trauma they experienced.

People with PTSD may be easily startled – flinching severely to a loud noise or an accidental touch. They may always feel ‘on guard,’ constantly monitoring the environment for danger. They may have trouble concentrating or sleeping. They may also have irritable or angry outbursts, acting out in reckless or destructive ways.

It’s important to note that these symptoms can also coexist with other mental illnesses. PTSD frequently co-occurs with other psychiatric disorders such as depression, obsessive-compulsive disorder, or substance abuse, which can make symptoms more severe.

If you or someone you know are experiencing these symptoms for over one month after a trauma, and they are interfering with daily functioning, it may be a good idea to talk to a doctor or other health professional.

It’s not exactly clear why some people develop PTSD after experiencing a traumatic event and some do not. Risk factors for developing PTSD include repeated trauma, having a past mental illness such as anxiety or depression, a history of trauma or abuse in childhood, having a poor support network after experiencing a trauma, and experiencing extra stressors after the trauma.

Scientists have made an effort to tease apart the contributions of genetics and environment in PTSD. Environment plays a large role in PTSD, as the experience of a traumatic event precipitates onset of the disorder. Evidence suggests that, like other psychiatric disorders, PTSD also has a strong genetic component. However, genetic tests for PTSD currently do not exist, nor is there a reliable way to predict who will develop the disorder following trauma.

While there’s no cure for PTSD, proper diagnosis, treatment, and management can help people cope with symptoms and live full and productive lives.

Treatments for PTSD can involve a combination of behavioral therapy, psychotherapy and medication. People with PTSD will need to work with healthcare and mental health professionals to determine the best treatment options for their particular needs and goals.

There are many types of psychotherapy options for PTSD. The overall goal of therapy in PTSD is to offer a safe and supportive environment for patients to work on improving symptoms, teach patients how to deal with the disorder, and boost their self-esteem.

Most PTSD therapies can be considered cognitive-behavioral therapy or CBT. CBT works on changing thought patterns that are disturbing one’s life. CBT for PTSD may include talking through traumas, focusing on where fears come from, or working on developing coping mechanisms to deal with the stress from the traumatic event. You can read more about CBT here.

Another type of treatment for PTSD is called Eye Movement Desensitization and Reprocessing or EMDR. EMDR is a complex type of therapy which relies primarily on eye movements, body sensations, and focused attention to improve beliefs about self and help process traumatic memories. You can read more about EMDR here.

Medications can help dampen some of the symptoms of PTSD. Antidepressants can reduce nightmares and flashbacks and help improve mood. Two antidepressants have been approved by the FDA to specifically treat PTSD. However, several other medications may be an option as well.

Antidepressants: Selective serotonin reuptake inhibitors (SSRIs) are typically used to treat PTSD. Paroxetine (Paxil) and sertraline (Zoloft) are the only two SSRI medications that are currently FDA-approved for treating PTSD. These drugs work by improving the availability of neurotransmitters in the patient’s brain so that it can function better. You can read more about medications here.

Many drugs can be used “off-label” to treat PTSD, meaning that they are not FDA-approved to treat the disorder, but studies show that they are nevertheless effective. These medications can include other antidepressants, monoamine oxidase inhibitors or MAOIs, antipsychotics, beta-blockers, or benzodiazepines.

If you have or think you have PTSD, talk with a doctor to determine the best treatment options for you.

PTSD can be scary and confusing for individuals and their loved ones, but recovery is attainable. Allowing the symptoms to interfere with daily functioning and cause other problems is perhaps the biggest risk associated with untreated PTSD. Many established and experimental therapies are available and can help individuals live normal lives, less encumbered by the devastating symptoms of PTSD.

Social anxiety disorder is an anxiety disorder characterized by the intense fear of being negatively evaluated, judged, or rejected in various social or performance-based settings. People struggling with social anxiety disorder experience excessive worry about how others will perceive them. They may fear being seen as stupid, ugly, or awkward. They may worry about offending someone unintentionally. They often assume that, no matter the context, people are automatically judging them.

It’s no surprise that this anxiety often causes avoidance of social interactions. People may turn down work opportunities or decline to attend weddings, dates, or parties. When a social situation cannot be avoided, the individual often experiences a pervasive sense of distress. This anxiety makes it difficult to enjoy social functions. Even when the individual can take a moment to have fun, they often find themselves ruminating over potential social mistakes after leaving the event.

Social anxiety disorder can manifest in different situations. Some people experience it in all social settings. Others may have concentrated anxiety in just one or a few situations. Some examples of these troubling situations include:

• Public speaking
• Interacting with strangers
• Making phone calls
• Attending parties
• Using public restrooms
• Eating in public
• Making eye contact
• Initiating conversations
• Entering a room
• Speaking to authority
• Taking exams
• Being the center of attention

Social anxiety disorder often results in excess shame and guilt. The individual usually recognizes the excessive worry but often feels powerless in stopping or reducing it. As a result, he or she may feel like something is seriously wrong, which can trigger self-deprecating thoughts and feelings. Unfortunately, if untreated, this vicious cycle often tends to perpetuate social anxiety.

People with social anxiety disorder tend to exhibit some or all of the following symptoms:

• Experiencing recurrent anxiety related to social or performance situations
• Experiencing intense anxiety when being exposed to the feared situation
• Identifying that the fear is excessive or disproportionate
• Avoiding stressful events altogether
• Experiencing anxiety that others will notice symptoms of nervousness and discomfort
• Experiencing avoidance, anxiety, or distress in a way that interferes with other areas of functioning (occupational, academic, relationships)
• Persistent anxiety that lasts at least 6 or more months

Many people also experience physical symptoms indicating anxiety. These symptoms may include:

• Blushing
• Shortness of breath
• Nausea and upset stomach
• Trembling and shaking voice
• Increased heart rate
• Hot flashes
• Sweating
• Fainting
• Panic attacks

It is important to note that these symptoms can also indicate the presence of another mental illness. For example, social anxiety disorder often coexists with conditions like depression, substance use disorders, eating disorders, and Attention Deficit Hyperactivity Disorder (ADHD).

Researchers have not discovered a single root cause for social anxiety disorder. Instead, the condition likely manifests from a variety of factors.

• Genetic: Anxiety disorders run in families. Individuals with anxiety can unknowingly pass down this condition generationally. This trend may be a result of both genetic and psychological variables.
• Trauma: Aversive experiences like physical, sexual, or emotional abuse may increase the susceptibility for someone developing social anxiety disorder. Trauma inherently challenges an individual’s sense of safety in the world. When people feel unsafe, they may be more hypervigilant, paranoid, and skeptical of other people and situations.
• Neurochemical: Research on brain chemistry indicates that deficits in serotonin and dopamine may contribute to social anxiety disorder. Serotonin supports regulating emotions and mood, and dopamine helps regulate pleasure. If there are imbalances in the brain, the individual may be more vulnerable to anxiety.

Although there isn’t a cure for social anxiety, proper diagnosing, treating, and managing can help people cope with their symptoms and live full and meaningful lives.

Individual therapy provides a safe and supportive environment for people who want to work on their social anxiety. There are numerous types of therapy options available, and particular methods will work better for some people than others.

• Cognitive-Behavioral Therapy (CBT): CBT is an evidence-based theoretical orientation that can treat social anxiety disorder. In CBT, clients learn how to identify and challenge irrational or distorted thoughts. They also learn healthier coping strategies for managing their anxiety when it arises. Many therapists help clients gradually work up to facing their feared situations. This exposure helps desensitize clients, which promotes more empowerment in daily living. You can read more about CBT here.
• Group Therapy: Anxiety support groups can be helpful for individuals to discuss their symptoms, practice new skills, and receive feedback from their peers. While group formats vary, most groups include a combination of education, practical skills, and open-ended processing. Groups may be open, which means clients can enter the group at any time, or they may be closed, which means that they have a set start and end date.

Antidepressants: Selective serotonin reuptake inhibitors (SSRIs) like Prozac, Zoloft, and Celexa help treat persistent symptoms associated with social anxiety disorder. Most clients start at the lowest dose, and they may gradually increase their dose if symptoms do not improve.

Benzodiazepines: Benzodiazepines like Xanax, Klonopin, or Ativan can help reduce anxiety symptoms. That said, these medications are typically only prescribed for short-term use, as they are sedative and can be habit-forming. You can read more about medications here.

Social anxiety disorder can be frustrating, scary, and confusing for individuals and their loved ones. People may feel hopeless about their condition; they may worry that they’ll never feel comfortable in certain social settings.

Recovery is attainable. No matter the circumstances, it is possible to manage even the most intense symptoms. Anxiety doesn’t have to define anyone; with the right treatment, it is possible to increase confidence and comfort within oneself and around others.

Agoraphobia is a type of anxiety disorder in which individuals experience significant fear in relation to open or crowded spaces, particularly when escape may be difficult. Individuals with agoraphobia perceive these environments as dangerous, potentially humiliating, and/or significantly uncomfortable. In severe cases, this disorder can result in an individual refusing to leave their home. This fear usually relates to (1) concern that one might experience a panic attack in this environment and/or (2) one will be overwhelmed by anxiety to the point of "losing control" (e.g., fainting, vomiting, loss of bladder control, death).

Historically, agoraphobia was only used to describe one’s experience of panic disorder. Individuals who experienced recurrent panic attacks were either described as having agoraphobia or not. However, in the most recent version of the Diagnostic and Statistical Manual of Mental Disorders (DSM-5), agoraphobia is now considered its own, independent diagnosis.

The anxiety or fear experienced within this disorder is disproportionate to the circumstance and is accompanied by a variety of physical symptoms that occur in anticipation, as well as during the actual experience. Common physical symptoms include:

• Tachycardia
• Sweating
• Nausea
• Chest pain
• GI issues
• Trembling
• Dizziness

In addition to physical symptoms, this condition causes individuals to avoid many situations, resulting in significant feelings of social isolation and difficulties maintaining a normal routine.

Although the specific feared circumstances largely depend upon the individual, some of the most commonly feared situations include: public transportation, stores, waiting in lines, crowded events, planes, parking lots, bridges, and parks.

There are a variety of circumstances that can increase the likelihood of developing agoraphobia. These include chemical or hormonal imbalances, genetic predisposition, personality characteristics (i.e., neuroticism), and previous trauma.

However, one of the most common occurrences is the development of agoraphobia following a panic attack. Panic attacks are incredibly uncomfortable episodes in which one experiences extreme physical symptoms of anxiety, as well as distressing thoughts such as the belief they are dying or having a heart attack.

Consider an individual who has a panic attack while waiting in line at a grocery store. This experience may cause them to significantly worry about having another attack. They may deem grocery stores as a trigger for panic, as well as potentially dangerous and humiliating. Given that they just experienced a panic attack, they may have particularly low self-efficacy in terms of their ability to cope with anxiety. Therefore, instead of enduring the anxiety associated with stores, they vow to never grocery shop in-person, which results in the development of agoraphobia.

As mentioned, avoidance is a key component of this disorder. Unfortunately, avoidance behaviors significantly impact work, finances, relationships, well-being, and overall quality of life. For example, a student who fears and avoids large crowds may find it quite difficult to attend large lecture classes. This could result in them skipping class, which would directly affect their grades and possibly their ability to graduate. Additionally, receiving a poor grade could increase stress and potentially develop negative thoughts about one’s ability or self-worth. Given this example, it is unsurprising that agoraphobia is often comorbid with depression.

Avoidance is a difficult pattern to break, as these behaviors are immediately reinforced by a decrease in anxiety and distress. Additionally, avoidance eliminates the ability to challenge one’s assumptions about a situation or environment. Going back to the student who is afraid of large classes – if this individual never attends a class, they never have the experience of being “okay” and safe in class. Alternatively, if they were able to attend multiple classes without panicking, over time, they could learn that this space is not as dangerous as once believed. This is referred to as exposure, which is an essential component of psychotherapy for agoraphobia.

Unfortunately, these avoidance behaviors can create a barrier for treatment. If someone experiences severe agoraphobia in which they are unable to leave their home, they may have a difficult time initiating and adhering to treatment. However, the recent development and advancement of telemedicine may offer a unique solution for these patients.

Agoraphobia is generally treated with medication, psychotherapy, or a combination of both. As is the case with most psychological disorders, a combination of therapy and medication is considered the most effective form of treatment.

Regarding medication, the classes most commonly prescribed for agoraphobia include selective serotonin reuptake inhibitors (SSRIs), serotonin-norepinephrine reuptake inhibitors (SNRIs), tricyclic antidepressants (TCADs), monoamine oxidase inhibitors (MAOIs), and benzodiazepines. In general, it often takes time for medication to begin demonstrating effects. Research suggests that a clinically significant change takes up to 8 to 12 weeks for some patients. Additionally, treatment effects related to anticipatory anxiety and avoidance can continue to increase over the first 6 to 12 months of treatment. You can read more about medications here.

In terms of therapy, cognitive-behavioral therapy (CBT) is the most supported evidence-based approach for agoraphobia. CBT is an active treatment in which the therapist and the patient work together to address symptoms and facilitating factors. This approach typically requires 10-20 treatment sessions; however, improvements have occurred in as few as 1 session. You can read more about CBT here.

Within CBT for agoraphobia, there is a focus on (1) the feared environments, (2) sensations of panic/anxiety in the body, as well as (3) cognitive distortions or appraisals that contribute to distress (e.g., “If I go to the movies, everyone will hear me panic”). The course of therapy includes a variety of objectives such as psychoeducation, self-monitoring, relaxation/coping training, exposure, and relapse prevention.

Exposure exercises are one of the most powerful techniques for agoraphobia. This step in treatment breaks the pattern of avoidance and fear. Typically, exposure treatment begins by creating a fear hierarchy, in which an individual lists their least-feared to most-feared situations. Next, the individual is taught a variety of relaxation strategies, in order to increase their ability to control symptoms of anxiety. Once the individual has practiced relaxation effectively, they will begin working through their hierarchy. Exposure will begin with the least-feared stimulus. Once the individual is able to successfully experience this activity and effectively manage their anxiety, they will move to the next level. Exposure can occur “in-vivo,” meaning in real life, via one’s imagination, and through virtual reality. This technique is quite beneficial, as individuals gain incredible self-efficacy and confidence surrounding their ability to control anxiety symptoms. Additionally, these activities provide the ability to directly challenge some of the assumptions related to the likelihood of experiencing panic.

In addition to CBT, there is also some evidence supporting the use of psychodynamic therapy, interpersonal psychotherapy, and acceptance-based approaches. Of these approaches, acceptance-based orientations appear to be quite promising; however, additional research is needed.

Hypochondria is a well-known term related to having fears of being diagnosed with a serious disease, often due to a misinterpretation of bodily symptoms. Although hypochondria used to be a diagnosable mental health condition, the most recent Diagnostic and Statistical Manual of Mental Disorders (DSM-5) reinterpreted this disorder into two classifications: (1) somatic symptom disorder and (2) illness anxiety disorder.

In general, somatic symptom disorder is used when the individual is experiencing actual physical symptoms; however, they are exacerbating the severity of these sensations and experience significant anxiety as a result. For example, this might occur if an individual has chronic headaches, yet believes these headaches are indicative of a brain tumor (despite having a negative MRI). As a result of this belief, this person spends considerable time and energy worrying about this symptom and attending multiple different medical appointments.

Illness anxiety disorder is a related condition, yet has some differences. In this disorder, an individual is overly preoccupied with being diagnosed with a serious disease or health condition. In this case, the individual generally does not experience physical symptoms or has very minor symptoms/sensations. As a result of this fear, people experience significant worry, attend multiple medical appointments, avoid health risks, and engage in many checking behaviors (i.e., web searches, body checks). Consider an individual with a family history of cancer. In order to meet criteria for illness anxiety disorder, this individual would spend considerable time worrying about a potential cancer diagnosis. Additionally, they might attend multiple appointments and experience minimal relief when given negative results. In this scenario, this fear would also significantly impair one’s functioning and may negatively impact their ability to work, maintain relationships, and have a daily routine.

Research suggests that of individuals who would have previously met diagnostic criteria for hypochondria, approximately 75% meet criteria for somatic symptom disorder, while 25% would be classified as illness anxiety disorder. Although both of these diagnoses cause functional impairment, an individual with somatic symptom disorder tends to experience more severe health anxiety and depression. Additionally, people with somatic symptom disorder have higher rates of panic disorder and agoraphobia, when compared to illness anxiety disorder.

Unsurprisingly, individuals with these concerns are more likely to attend appointments with primary care physicians or medical specialists, compared to psychologists or psychiatrists. It is important to mention that these conditions do not include individuals who simply have unexplained physical symptoms – in order to meet diagnostic criteria, the person must also experience significant symptoms of anxiety and resulting functional impairment.

Although some screening instruments have been created (e.g., Patient Health Questionnaire – 15, Somatic Symptoms Scale – 8), individuals with these concerns are generally diagnosed via an in-depth clinical interview, alongside other comprehensive medical exams. It has been suggested that screening instruments can lead to false positives; therefore, they should be followed-up with a clinical interview prior to diagnosis.

For somatic symptom disorder, diagnosis can take a considerable amount of time. Given that these individuals do experience physical symptoms, diagnosis often first requires extensive physical and medical examination.

Individuals with these conditions can often feel invalidated, as they may consistently hear that the medical exams do not show evidence of their symptoms/concerns. Although this message is often meant to provide reassurance, this can actually lead the individual to mistrust their provider or feel as though their concerns are minimized. This is particularly true when individuals are experiencing physical symptoms. In these cases, it is incredibly important for providers to first validate one’s experience of these symptoms.

Individuals with these concerns should be educated on the role of anxiety and stress in generating and exacerbating physical symptoms. For example, consider an individual who experiences chronic headaches. Let’s assume that this individual believes there is something significantly wrong with their neurological functioning. The presence of this belief, as well as the associated symptoms of anxiety, can significantly increase one’s stress, which can lead one to develop a headache and experience impairments in cognitive functioning (e.g., concentration and memory). Alternatively, when experiencing a headache, this person may be particularly focused on this bodily sensation. When this occurs, the individual typically experiences anxious thoughts and emotions, which actually exacerbate symptoms of the headache.

When working with this patient, it is important that they are told their pain and symptoms are real. They are experiencing headaches and cognitive impairment. Additionally, it is important to communicate that it makes sense that these symptoms lead to anxiety because these experiences can be quite troubling. Once this validation and empathy has been provided, it is important to then discuss the role of anxiety and stress.

Treatment for these conditions generally begin with one’s primary care physician, since these individuals usually present to medically-focused providers. For this phase of treatment, it is encouraged that individuals attend regular visits and maintain care with the same provider(s), as opposed to meeting with multiple providers. Additionally, this phase of treatment is focused on diagnostic testing and improving one’s functioning. Once the potential medical concerns have been ruled out, the next step is usually to pursue psychotherapy.

Cognitive-behavioral therapy (CBT) is considered to be the most effective therapy. Research on CBT in this population has demonstrated improvements in illness-related thoughts and behaviors, anxiety, and depression. In general, therapy will focus on providing education, introducing coping strategies, and challenging illness-related beliefs (while validating one’s physical experiences). Fortunately, individuals generally begin seeing improvements within one month of beginning therapy. You can read more about CBT here.

The introduction of relaxation and coping skills can be quite powerful. Practicing these skills, particularly in moments of stress, often reinforces the relationship between stress and anxiety and symptoms that worsen. For example, consider the previous individual who experiences chronic headaches. Let’s assume that this individual begins to experience a headache. Instead of being overly focused on these sensations, he or she begins to practice relaxation strategies. As a result, he or she experiences less anxiety, as well as a reduction in physical symptoms. This experience can be very influential, as it helps individuals feel empowered and experience more control over their physical symptoms.

Medication has also been studied; however, some studies have shown less improvement when compared to CBT. Additionally, this population may be particularly fearful of medication and the potential side effects. Antidepressants have emerged as a potential second or third line treatment for this population. You can read more about medications here.

Individuals with significant fears related to their physical health may meet criteria for illness anxiety disorder or somatic symptom disorder. Although diagnosis of this concern can be somewhat prolonged, particularly when one is experiencing physical symptoms, treatment, especially CBT, seems to be quite promising.

Specific phobias occur when individuals experience significant fear and anxiety in response to a particular object or situation. This fear is disproportionate to the actual threat of the situation and results in the individual having acute physical anxiety, including panic attacks. Interestingly, people who experience phobias are aware the fear is excessive; however, this awareness does not diminish their experience of panic.

The following are symptoms of the anxiety that are associated with phobias including, but no limited to:

• panic attacks
• sweating
• dry mouth
• chest pain or tightness
• difficulty or rapid breathing
• disorientation
• dizziness
• tachycardia

These symptoms occur in the presence of the feared stimulus, as well as in anticipation of this stimulus. For instance, consider an individual with a phobia related to flying on an airplane. This individual will likely experience anxiety when they book their flight, the night before travel, the morning of their trip, and during their time in the airport. It is most likely that symptoms will become worse over time, increasing as the individual gets closer to the actual situation (i.e., flying on a plane).

Phobias present in a variety of different forms. The Diagnostic and Statistical Manual of Mental Disorders (DSM-5) identifies five formal groups of phobias (i.e., animal, natural environment, blood-injection-injury, situational and other); however, these categories are quite general and can include many variations. For example, within the “animal” subtype, individuals may have a phobia related to spiders, snakes, or dogs.

Although the DSM-5 only includes these general classifications, there are a variety of different terms that are used by the general public relating to specific fears. For example, the DSM-5 would diagnose a phobia of spiders as “Specific Phobia, Animal Subtype.” However, many individuals may use the term “arachnophobia” to more specifically define this condition. Claustrophobia and cleithrophobia are two of these terms used to more specifically explain one’s fear. Although they are quite similar, they have an important distinction.

Claustrophobia, or the fear of confined or crowded spaces, is one of the most commonly known phobias. Technically, this phobia falls under the “situational” classification in the DSM-5, as individuals with this disorder experience significant fear related to situations in which one has limited space and feels “closed in.” Some situations that would be distressing for individuals with claustrophobia include elevators, planes, crowded spaces, bathrooms, MRI machines, and windowless rooms.

Cleithrophobia, a lesser known phobia, relates to the fear of being trapped, locked in, or unable to escape. Often, this fear is related to a concern that one will experience panic or significant discomfort, yet will be unable to leave the situation. Even though this phobia would technically require the same diagnosis as claustrophobia (i.e., Specific Phobia, Situational Type) and similar situations may trigger symptoms (e.g., elevators, planes), there is a significant difference.

For example, imagine someone being inside of a closet. If this individual had claustrophobia, sitting in the closet would be distressing. Alternatively, if the individual had cleithrophobia, they would only experience panic if the closet door was locked. If they could open the closet door, they would likely not experience anxiety.

Although claustrophobia and cleithrophobia do have differences, individuals with these concerns will likely follow similar treatment plans.

Generally speaking, individuals with specific phobias are first encouraged to pursue psychotherapy, prior to medication. Although there has not been a direct comparison between therapy and medication for this patient population, research for therapy consistently demonstrates treatment effects, while medication trials have yielded mixed results.

Cognitive-behavioral therapy with exposure is the most supported therapeutic approach for treating specific phobias.

Exposure is an essential component of the therapeutic process. In layman’s terms, this strategy refers to "facing your fears." This technique is based on decades of behavioral research and suggests that repeated confrontation of a feared stimulus, while effectively managing anxiety, will eliminate one’s fear response.

Needless to say, this can be quite scary and difficult for patients to hear. The majority of individuals attend therapy in hopes of feeling better – asking them to willingly endure panic and anxiety symptoms can be challenging. However, it is the therapist’s job to help the patient feel confident and comfortable. This is done through significant education, introduction and practice of multiple coping skills, as well as the gradual progression through exposure activities.

Systematic Desensitization refers to the concept of steadily working through each level of exposure. Individuals are asked to identify multiple situations or stimuli that may create an anxiety response. Next, they are instructed to rate each one of these situations in terms of the level of fear they will experience (0 to 100; this number is referred to as “subjective units of distress,” or SUDs).

In the case of claustrophobia, an example of this hierarchy may look like this:

• Looking at a photo of an elevator (10)
• Watching a video of people in an elevator (25)
• Thinking about being in an elevator alone (35)
• Thinking about being in an elevator with other people (40)
• Watching an elevator open and close (50)
• Standing in the elevator with the door open (60)
• Standing in the elevator with the door open, with other people (75)
• Taking the elevator alone (90)
• Taking the elevator with other people (99)

Therefore, exposure would begin with the first step – looking at a photo of an elevator. The individual would be asked to engage in this activity, while practicing their relaxation and coping strategies. Throughout the course of each exposure exercise, it is expected that one’s anxiety will increase slightly. However, after sitting in the exercise for an extended period of time, the individual’s symptoms will begin to decrease. Since the exposure activities are completed in a gradual manner, when the individual reaches the last step, they typically feel much more confident about their ability to confront and navigate this situation.

Specific phobia is a diagnosable mental health concern which is characterized by extreme fear of a particular object or situation. This fear causes physical symptoms of anxiety, which can be quite uncomfortable, ranging from hyperventilation, sweating, choking sensations, tachycardia, chest pain/tightness, and shakiness. Due to this fear, individuals may engage in avoidance behaviors that minimize the chances of having to interact with the feared situation. Often, these avoidance behaviors can significantly disrupt one’s life and overall functioning. This disorder has a relatively high prevalence rate, as approximately 5% to 10% of the U.S. population are estimated to have a specific phobia.

The term "phobia" is relatively well known and many words include this phrase to identify specific fears – such as claustrophobia (fear of enclosed spaces) or arachnophobia (fear of spiders). However, the Diagnostic and Statistical Manual of Mental Disorders (DSM-5) identifies five official subtypes of specific phobias. These include: animals, situations, natural environment, blood-injection-injury, and other.

There is not one particular cause of a phobia – instead, risk of developing this disorder is associated with a variety of biological, psychological, and social/environmental factors.

Treatment of specific phobias is incredibly effective and largely uses psychotherapy (i.e., cognitive-behavioral therapy with exposure) and, in some cases, medication. However, individuals with phobias are often hesitant to pursue treatment. This is likely attributable to avoidance behaviors inherent to the disorder, as treatment requires individuals to discuss, understand, and face their feared stimuli.

Avoidance of treatment may also relate to feeling embarrassment about this fear, as individuals with phobias are often aware their response is disproportionate. It is important to note that practitioners trained in the mental health field truly understand this disorder and should not show any judgment or criticism. They should demonstrate understanding, empathy, and hope. Finding a mental health practitioner with these traits is key.

Interestingly, treatment may not be recommended for all individuals with specific phobias. The decision to pursue treatment is largely dependent upon the functional impairment associated with this fear. In other words, the extent to which this phobia interferes with one’s daily functioning, distress, and overall quality of life. For example, if an individual reports having a mild phobia related to heights, yet does not have to encounter heights on a regular basis, they may be able to maintain an overall good quality of life without treatment.

When determining one’s functional impairment, it is important to consider the specific fear, one’s personal circumstances, as well as the severity of the phobia itself. This is discussed further below.

Animal-related phobias occur most commonly in relation to spiders, snakes, insects, and dogs. Interestingly, this subtype is generally associated with less functional impairment, as individuals are usually able to effectively avoid particular animals without tremendous disruption of their lives. However, this is not meant to be minimized, as people with severe phobias will experience significant distress regardless of the feared situation. To illustrate, consider an individual with a phobia of snakes. In general, the avoidance of snakes would not significantly limit one’s life and ability to perform day to day tasks. However, if this phobia is so severe it causes the person to avoid going outside completely, this would obviously have a significant impact on one’s life.

Situational phobias relate to when individuals fear stimuli such as planes, elevators, public transportation, bridges, and enclosed spaces. Research suggests that this type of phobia is one of the most impairing categories (along with the blood injection injury subtype). However, as previously mentioned, the functional limitation associated with these phobias is largely dependent on the actual feared situation, as well as one’s circumstances. For instance, if an individual lives in New York City and does not own a car, a phobia of public transportation is going to be incredibly limiting. Alternatively, this same phobia would matter much less if the individual lived in a suburb and largely relied on their own car for transportation.

Phobias relating to the natural environment commonly include fears of storms, water, and heights. When compared to the animal category, this category has been associated with more anxiety, depression, and social problems. As mentioned before, the specific level of functional impairment changes depending upon the severity, specific fear, and an individual’s circumstances. An individual with a fear of heights will likely be able to compensate for this using avoidance behaviors and not experience a significant disruption in their routine; however, an individual with a fear of sunlight will have much more difficulty.

The blood injection injury type of phobia occurs when individuals fear needles or invasive medical procedures, such as surgeries. It is estimated that this phobia occurs in 3-4% of the general population. This subtype has a relatively large “family tendency,” suggesting that genetics could play a role in its etiology. Regarding functional impairment, this subtype is actually quite concerning, as individuals will often avoid seeking medical assistance and choose not to attend medical appointments. Symptoms of anxiety will often emerge as a result of sitting in a medical clinic or hospital, so individuals are likely to avoid these situations completely. Research has reported that between 5% and 15% of the population declines necessary dental treatment due to the fear of oral injections.

Unlike other subtypes, individuals with a blood injection injury phobia often experience a vasovagal response, which can result in fainting at the sight of blood, as well as in anticipation of physical injury or injection. If an individual reports having this response, it can actually change some aspects of treatment. Specifically, when working through exposure therapy, usually individuals are encouraged to practice relaxation strategies to regulate their symptoms of anxiety. Alternatively, individuals with the tendency to faint are actually instructed to tense their bodies (and remain seated) to reduce the risk of fainting.

Lastly, the “other” subtype is perhaps the most generic and heterogeneous, as it includes all other types of phobias that do not fit within the four previous categories. Some common examples of this include fear of vomiting or choking, loud sounds, or costumed characters (e.g., clowns, mascots).

Although there are some differences between these categories, treatment will largely follow a similar format. As mentioned previously, cognitive-behavioral therapy with exposure is the most supported approach in addressing this condition; however, in some cases, medication is also implemented. Furthermore, effectiveness of treatment is consistent across the five subtypes, suggesting that these categories do not differ in terms of difficulty to treat. Therefore, regardless of the type of phobia, individuals should feel hopeful about their treatment options.

Burnout is the type of extreme stress or fatigue that can lead to everything from respiratory problems to gastrointestinal issues and is officially recognized as a mental health concern. According to the World Health Organization (WHO), “burnout is characterized by feelings of energy depletion or exhaustion; increased mental distance from one’s job, or feelings of negativism or cynicism related to one’s job and reduced professional efficacy.”

Burnout is defined as a state of emotional, physical and mental exhaustion caused by excessive and prolonged stress. It happens when you feel overwhelmed and emotionally drained and unable to meet constant demands. While burnout can occur in any area of our lives and any profession, much of the burnout research focuses on work related situations.

Some symptoms that you may experience may show up as signs of physical, mental and/or emotional health as a result of stress related to a job or workplace.

• Reduced performance and productivity
• Anxiety
• Low mood and difficulty concentrating
• People tend to emotionally distance themselves
• Feel numb about their work
• Lowered immunity, frequent illnesses
• Frequent muscle pain
• Change in appetite or sleep habits
• Feeling tired and drained most of the time
• Feeling helpless, trapped and defeated
• Loss of motivation
• Increasingly negative outlook
• Decreased satisfaction and sense of accomplishment
• To-do list: everything

Although burnout can occur in any field or occupation, it is most prevalent in the caring professions of medicine, emergency response, social work, counseling and teaching.

Some common causes of burnout are:

• Workload - Individuals who feel chronically overloaded with an insurmountable amount of tasks
• Insufficient recognition - Individuals feel taken for granted and underpaid
• Unfairness - Individuals who experience favoritism, inequality, discrimination and other forms of maltreatment
• Lack of control - An individuals’ inability to control certain aspects of circumstances
• Mismatched values - An individuals’ and an organizations’ values are different and this affects individuals’ productivity and moral
• Conflict - Attempts to communicate with team members results in conflict and a lack of resolution

What are some things you can do to help prevent or deal with burnout? It is tricky when we are emotionally and physically drained and are burned out or on the road to a burnout. Situations may seem hopeless and overwhelming and seem difficult to overcome.

Reach out to friends and family: Do not be afraid to get help or reach out to others for support as it may be the most effective way to help you get back on your feet. Speaking to others face to face with a great listener is one of the quickest and most powerful ways to help calm your nerves and lower your tension and stress levels. A good listener does not have to have the capability to make your problem go away but just to be there for you to listen and not judge you. Call on for help from your family and loved ones and confide in them with your situation to get help and advice.

Exercise: Builds up your mental and physical health to become more resilient and stronger and able to withstand mental and physical stress. It also lowers stress, anxiety levels and muscle tension.

Diet: Eat a well balanced diet that includes less sugar and refined carbohydrates to avoid crashes in energy and to keep your energy levels steady. Avoiding the use of nicotine and alcohol will also help to reduce anxiety from burnout.

Connect: Connecting with a religious, social or support group that provides an environment where you can be yourself and not feel judged can be helpful. It is a way to find support to help you deal with stress, anxiety and treating or preventing a burnout. Also, developing a strong connection at work with colleagues can help lower and battle the effects of burnout.

Take a break: If you have the ability to take personal or sick time from your job, take a mental health day and spend time doing something you enjoy or just relax. Schedule a vacation if it is feasible with your financial and employment situation.

Sleep: Getting at least 6-8 hours of sleep per night is recommended for adults to improve productivity and reduce the effects of stress and anxiety.

Relaxation: Dedicate time to relax and find techniques that relax your body and mind and that help you unwind and enhance the body’s relaxation response.

Learn how to reduce stress when it happens instantly and develop techniques to help you lower it in its tracks. Try to deal with troublesome feelings and thoughts and encourage yourself to relieve stress to prevent a burnout. Try to find meaning and joy in your job to increase your overall health and happiness.

It is always important to evaluate our work lives and mental health in correlation to our jobs. Watch out for factors that predispose you to burnout and always analyze your physical and mental health. Most people have many days where they feel overloaded, unappreciated and have to push themselves to get out of bed. If you feel like this most of the time, you may be burned out.

The process of burnout is a gradual process and does not happen in one day. The signs and symptoms can be subdued at first, but may get worse over time. Consider the early symptoms as warning signs and give attention to them. By paying attention and being aware of the symptoms, you can play an active role in your mental health and prevent a major burnout.