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Depression & Stress
Coping with Anxiety Disorders

Feelings of nervousness, anxiousness, worry, fear, or anxiety may have you wondering if you need to see a mental health professional to relieve your anxiety symptoms. Many people experience anxiety occasionally, but when your level of anxiety begins to interfere with your daily activities, it could indicate that you are suffering from an anxiety disorder.

In the past 6 months:

  • Have you experienced excessive anxiety and worry about your daily activities, such as work or school performance?
  • Does your anxiety or worry interfere with your normal routine, job performance, social activities, or relationships?

If so you may be one of the 19 million American adults suffering from an anxiety disorder. These disorders fill people's lives with overwhelming anxiety and fear. Unlike the relatively mild, brief anxiety caused by a stressful event such as a business presentation or a first date, anxiety disorders are chronic, relentless, and can grow progressively worse if not treated.

Effective treatments for anxiety disorders are available, and research is yielding new, improved therapies that can help most people with anxiety disorders lead productive, fulfilling lives. If you think you have an anxiety disorder, you should seek information and treatment.

Each anxiety disorder has its own distinct features, but they are all bound together by the common theme of excessive, irrational fear and dread.

Generalized Anxiety Disorder
"Everyone knows I’m a worrier. I always feel keyed up and unable to relax. At times it comes and goes, and at times it’s constant. It could go on for days. I'll worry about what I’m going to fix for a dinner party, or what would be a great present for somebody. I just can’t let something go.

"I'm having sleeping problems. There are times I'll wake up wired in the middle of the night. I have lightheaded. My heart races and pounds. And that makes me worry more. I’m always imagining things were worse than they really were: when I get a stomachache, I'd think it was an ulcer.

"When my problems are at their worst, I miss work and feel just terrible about it. Then I worry that I’ll lose my job.”


Do these thoughts sound familiar? Generalized anxiety disorder (GAD) is more than the normal anxiety we all experience day-to-day. It's chronic and filled with exaggerated worry and tension, even though there is little or nothing to provoke it. Having this disorder means always anticipating disaster, often worrying excessively about health, money, family, or work. Even though the source of the worry is hard to pinpoint. Simply the thought of getting through the day can provoke anxiety.

People with anxiety disorder can't seem to shake their concerns, even though they usually realize that their anxiety is more intense than the situation warrants. Their worries are accompanied by physical symptoms, such as fatigue, headaches, muscle tension, muscle aches, difficulty swallowing, trembling, twitching, irritability, sweating, hot flashes, lightheadedness, breathlessness, nausea, and frequent trips to the bathroom. Individuals with GAD seem unable to relax, and often startle more easily than others. They tend to have difficulty concentrating and have trouble falling or staying asleep.

When impairment associated with GAD is mild, people with the disorder may be able to function in social settings or on the job. If severe, however, GAD can be very debilitating, making it difficult to carry out even the most ordinary daily activities. GAD affects about 4 million adult Americans and about twice as many women as men. It is diagnosed when someone spends at least 6 months worrying excessively about a number of everyday problems.

Generalized anxiety disorder rarely occurs alone, however, it is usually accompanied by another anxiety disorder, depression, or substance abuse. These other conditions must also be treated. Other anxiety disorders include: panic disorder, obsessive-compulsive disorder, post-traumatic stress disorder (click here for more on PTSD), social anxiety disorder, and specific phobias.

Treatment of Anxiety Disorders
Effective treatments for anxiety disorders have been developed through research. In general, two types of treatment are available for an anxiety disorder- medication and specific types of psychotherapy. The choice of one or the other, or both, depends on the patient's and the doctor's preference, and also on the particular anxiety disorder. For example, only psychotherapy has been found effective for specific phobias.

Before treatment can begin, the doctor should conduct a careful diagnostic evaluation to determine whether your symptoms are due to an anxiety disorder, which anxiety disorder(s) you may have, and what coexisting conditions may be present. Anxiety disorders are not all treated the same, and it is important to determine the specific problem before embarking on a course of treatment. Sometimes alcoholism or some other coexisting condition will have such an impact that it is necessary to treat it at the same time or before treating the anxiety disorder.

When you undergo treatment for an anxiety disorder, you and your doctor or therapist will be working together as a team. Together, you will attempt to find the approach that is best for you. If one treatment doesn't work, the odds are good that another one will. So don't give up hope.

Psychiatrists or other physicians can prescribe medications for anxiety disorders. These doctors often work closely with psychologists who provide psychotherapy. Although medications won't cure an anxiety disorder, they can keep the symptoms under control and enable you to lead a normal, fulfilling life.

Before taking medication for an anxiety disorder ask your doctor to tell you about the effects and side effects of the drug he or she is prescribing. Then work together with your doctor to determine the right dosage of the right medication to treat your anxiety disorder.

Psychotherapy involves talking with a trained mental health professional, such as a psychologist to learn how to deal with the anxiety disorder. Research has shown that cognitive-behavioral therapy (CBT) is a form of psychotherapy that is effective for several anxiety disorders.

Cognitive-behavioral therapy has two components. The cognitive component helps people change thinking patterns that keep them from overcoming their fears. The behavioral component seeks to change people's reactions to anxiety-provoking situations. A key element of this component is exposure, in which people confront the things they fear. Another technique is to teach the patient deep breathing as an aid to relaxation and anxiety management.

A major aim of CBT is to reduce anxiety by eliminating beliefs or behaviors that help to maintain the anxiety disorder. To be effective, CBT must be directed at the person's specific anxieties. During treatment, the therapist probably will assign "homework"—specific problems that the patient will need to work on between sessions.

Medication may be combined with psychotherapy, and for many people this is the best approach to treatment. Psychologists often work closely with a psychiatrist or other physician, who will prescribe medications when they are required. When you find a health care professional the two of you are working together as a team. Together you will develop a plan to treat your anxiety disorder.

It is important to give any treatment a fair trial. And if one approach doesn't work, the odds are that another one will, so don't give up. If you have recovered from an anxiety disorder, and at a later date it recurs, don't consider yourself a failure. Recurrences can be treated effectively, just like an initial episode. In fact, the skills you learned in dealing with the initial episode can help in coping with a setback.

The family is important in the recovery of a person with an anxiety disorder. Ideally, the family should be supportive while not perpetuating the person's symptoms. If the family tends to trivialize the disorder or demand improvement without treatment, the affected person will suffer.

Get Help for Anxiety Disorders
If you, or someone you know, has symptoms of anxiety you can get help from a mental health professional. It's best to look for a professional who has specialized training in cognitive-behavioral therapy.

Dr. Kathy Marshack can help you. She is accepting new clients and has two office locations for your convenience. If you live in the Portland, Oregon or Vancouver, Washington area (or can drive to these locations) please call to set up your first appointment. See Therapy FAQs for more information. Please give us a call at (360) 256-0448 or (503) 222-6678 or email us at info@kmarshack.com.