Breaking Through

Experts are learning more every day about anxiety disorders, helping many to conquer their fears

At 65, Rita Clark is still enjoying her new life. She appreciates driving her car long distances, and still marvels at trips she makes to the grocery store or the bank alone. Clark is happy to do these everyday tasks — activities most of us take for granted — because, for 20 years of her life, panic attacks kept her from doing them. Just going out in public in those days was a huge obstacle, but she couldn’t pin her physical symptoms or her fears on any one source. She was just scared.

“The main fear was the fear of losing control,” Clark recalls. “I was afraid that I was going crazy and that if I told anybody, including my doctor or any family member, they would take my children away.” A newspaper article finally gave Clark hope that her symptoms could be the result of an anxiety disorder, one of a family of treatable conditions which can include panic disorder, agoraphobia, obsessive-compulsive disorder (OCD), post-traumatic stress syndrome, and generalized anxiety. “I was stunned,” she says. “I thought, ‘Oh my God, it has a name.’”

That was in 1983, when a lot of people still thought of anxiety as a passing sensation — an unpleasant emotional state you could easily improve with a cold beer or some time to relax. Jerilyn Ross, president and CEO of the Anxiety Disorders Association of America (ADAA), was part of the first wave of psychologists during this time who focused on treating anxiety and drawing sufferers like Clark out of hiding. “There really wasn’t any field then, and nobody knew what to do, where to go,” Ross says. “So a lot of these people just ended up feeling like hypochondriacs, feeling alone and isolated. Sometimes people would end up getting secondary problems like depression or turning to drugs or alcohol. And many were just lost in the cracks.”

Today the ADAA estimates that more than 40 million adults in the United States suffer from an anxiety disorder, making it the most common mental illness in the country. Experts debate the causes and triggers of anxiety disorders, but they’re learning more every year about how to diagnose and treat them.

Out of the Blue

It’s possible for a particularly stressful event to trigger an anxiety disorder, especially for someone who doesn’t manage stress well, says Richard Shadick, PhD, director of the New York–based Pace University Counseling Center.

Clark’s first panic attack, however, came out of the blue. “I was playing cards,” she says. “And I had this unbelievable panic attack, during which I fell to the floor and scared people. And I had to go back home right away.” The next day, her doctor diagnosed her with low blood pressure. “I bought into that, but I knew in my heart that it was something much worse,” she adds.

Ross says that kind of story is quite common among anxiety patients, who experience symptoms as varied as nausea, dizziness, shortness of breath, and chest pains. “Years ago — and this happens today too — someone would think they were having a heart attack, then they’d go to the emergency room. They’d go to the cardiologist, they’d go to the neurologist, and they’d have the million-dollar workup. And then someone would say, ‘Maybe it’s just in your head,’ as if that’s not serious. They’d say, ‘Sorry, we can’t help you.’”

The phrase “in your head” can be misleading to patients, since it implies that the feelings they’re experiencing are somehow imagined. Studies show that neurophysiology actually plays a big role in determining whether someone will develop an anxiety disorder. “Post-traumatic stress disorder is really the only anxiety disorder where the cause is pretty clear — it’s trauma-induced,” says Thröstur Björgvinsson, PhD, a psychologist at the Houston-based Menninger Clinic and associate professor at Baylor College of Medicine who specializes in treating people with OCD. With other anxiety disorders, he says, “it looks like there’s a strong genetic component. There’s a strong possibility that pharmacological brain chemistry may affect it.”

Clark says she suspected there was a genetic component to her anxiety even before research showed the connection. “The reality was mind-boggling,” she says. “Because I see different components, though maybe not as severe as what I had, in other family members.”

Into the Light

Even children, perhaps the most vulnerable members of the family unit, can develop serious problems with anxiety. Björgvinsson says that about a third to half of patients who suffer from OCD, for example, experience symptoms in their childhood or adolescent years — making accurate diagnosis and treatment even more important.

Early treatment is especially crucial, Ross adds, because anxiety patients will often develop secondary problems, like depression. Clark started out with panic disorder at age 23, and she developed agoraphobia as a means of avoiding panic-inducing situations. “I was narrowing my world to prevent this from happening again,” she says.

Treatment programs for anxiety disorders commonly include a combination of medication and cognitive behavioral therapy. Björgvinsson says an approach known as exposure and response prevention has been found to be particularly effective. The therapy involves actually placing patients in situations that will trigger their anxiety, forcing them to face their fears head-on. “If you go after those elements, you can use them quite effectively in cognitive behavioral therapy, even if you don’t know the cause [of the anxiety],” Björgvinsson explains.

Some basic lifestyle changes can also be effective in the management of anxiety. Shadick says one area of increased interest is exercise. “Countless studies have talked about the beneficial effects of moderate exercise on improving one’s mood, decreasing anxiety, improving sleep, and managing weight loss,” he says.

Clark, who is the national consumer education chair for the ADAA, used a combination of cognitive behavior therapy and the drug Xanax — which she took only on an as-needed basis — to tackle her anxiety. But she also found meditation practice to be helpful. She hopes her progress will inspire others.

“I’m an absolutely new person,” Clark says. “I’ve learned to love myself. I have a closer relationship with my children. I’ve gone back to working full-time after being off for 30 years. But the most comforting realization was that I wasn’t alone.”

Good Medicine

Since anxiety disorders have biological components, medication can be an essential part of a patient’s treatment and recovery. “Taking medication can help a client decrease the level of intensity of the symptoms, so [he or she] can work more effectively,” explains Richard Shadick of the Pace University Counseling Center.

Jerilyn Ross, CEO of the ADAA, offers the basic facts about two major groups of medications available to anxiety patients:

Antidepressants

• Long-lasting
• Take time to get into the body’s systems, sometimes up to a few weeks
• Usually taken regularly for at least a year

Antianxiety drugs

• Short-term results
• Enter the body’s systems quickly
• Usually taken before entering an anxiety-inducing situation