Dr. Deborah L. Ross, PHD

Collectively, anxiety disorders are the most common mental health issues diagnosed in the United States -- even more common than depression. Women are more likely than men to be diagnosed with anxiety, and it is extremely common for a person with anxiety to have another illness at the same time, such as depression, a physical illness, or substance abuse.

Treatment for anxiety usually involves medication and psychotherapy together. Medications used may include antidepressants (which also work for anxiety), anti-anxiety medications, or beta blockers (which can be used to control the physical symptoms of anxiety). Psychotherapy can be useful to teach patients new ways of thinking and reacting so that they can manage their feelings of worry and fear. Support groups can also be very effective for anxiety, and they can be a form of treatment themselves for social phobias. Stress management, relaxation techniques, and meditation all help reduce feelings of anxiety or of being out of control. Finally, having a strong support network of family and friends is an excellent way to help manage the difficulties of life with anxiety.

CBT is one of the most widely studied forms of psychotherapy, and it has been shown to be extremely effective for a variety of mental illnesses. Some of the issues that respond well to CBT include mood disorders, personality disorders, eating disorders, substance abuse, sleep disorders, and psychotic disorders. In some cases, CBT has been shown to be as effective or even more effective than medication. One of the interesting things that the scientific study of CBT has shown is that CBT actually changes the way the brain works, physically improving its function.

CBT differs from traditional psychotherapy in a few key ways. One of the most important distinctions is the emphasis on the power and responsibility of the patient in CBT. The patient will be encouraged to be the one asking the questions in CBT therapy, and most patients are assigned homework to complete outside of therapy sessions. There is a concept in CBT that everyone has power the power to change how they feel, even if they cannot control the situation, and this can be very empowering for patients. Because of this power shift, the therapist-client relationship is not as critical to success in CBT as it is in other modes of therapy. Patients should still get along well with their therapists, but they do not need a deep, dependent emotional connection to them. Finally, because CBT often treats a specific issue or problem, it is usually shorter in duration than traditional therapy. While some therapies may continue for years, CBT lasts on average just 16 sessions.

• Accidents
• Sexual or physical assault
• Combat
• Childhood abuse
• Domestic abuse
• Natural disasters
• Torture and kidnapping

People who have experienced significant and repeated trauma are more likely to develop PTSD. Those who have disorders like depression or a family history of depression may also be more prone to PTSD. PTSD symptoms typically begin one month to one year following the traumatic event. There are four main categories of PTSD symptoms:

• Intrusive memories: Intrusive memories include unwanted memories, feelings of reliving the traumatic event, distressing nightmares, and emotional disturbances from triggers (signs that serve as reminders of the traumatic event). Intrusive memories can lead to elevated heart rate, anxiety, combativeness (fight), withdrawal (flight), and many other responses.
• Avoidance: Avoidance is an attempt to avoid speaking or thinking about an upsetting event. People with this response might also try to avoid certain people or locations that prompt memories of an event.
• Changes in physical and emotional reactions: These changes may include difficulty sleeping, hypervigilance, self-destructive behavior, and feelings of guilt and irritability.
• Alterations in cognition and mood: Alterations can cause negative self-beliefs, depression, shame, and detachment from others.

The intensity and frequency of these symptoms can vary over time. PTSD symptoms may suddenly return after disappearing for years. Many PTSD patients find treatment helps to gradually reduce their symptoms over time.

The most common treatments for PTSD are psychotherapy and oral medications. Psychotherapy for PTSD can include cognitive therapy (therapy to change thought patterns), exposure therapy (therapy to confront memories of the traumatic incident) and eye movement desensitization and reprocessing therapy (EMDR). EMDR integrates exposure therapy with guided eye movements to help patients confront and process their trauma. Certain oral medications may help with PTSD, such as antidepressants and anti-anxiety medications. Self-care, support groups, and relaxation may also benefit those with PTSD.

The path to overcoming PTSD can be long and challenging and people with PTSD can benefit greatly by seeking professional treatment from a mental health care provider. Treatment can reduce PTSD symptoms, provide essential coping strategies, and improve one's quality of life.