As a psychiatrist, I’m impressed by how ubiquitous anxiety is. Yesterday, when I attended a women’s faculty meeting, the featured speaker, a leading professor and researcher in cardiology, described her arduous road to the top. Her credentials and accomplishments were outstanding in every way. During the Q&A, I raised my hand and asked her if she had any regrets about her life. She smiled and said she had only one: that she was riddled with terrible anxiety throughout her career and wished she could have relaxed more.
I understood her completely, although I could see that the audience was shocked. Most people probably wondered how she could feel that way when she was so brilliant and successful. What the general public doesn’t realize is that some of the most successful people are plagued by anxiety and feelings of inadequacy every day. Doctors, lawyers, and prominent business people report to me that they feel like they are imposters in their field because they experience such nervousness.
Anxiety is an uneasiness, an apprehension of danger about people, places, things, and situations, when often there is no danger. It manifests physically as restlessness, muscle tension, rapid heartbeat, sweating, and shortness of breath. Most of the fear driving it is baseless. The anxious person may realize it, but she or he can’t stop projecting negativity onto his or her environment. For instance, if I walk down a dark alley at midnight, I’m frightened because I imagine muggers lurking in the shadows. Even if I were to be given information that there were no muggers present, it would be difficult to control my fast beating heart, or my tense muscles and cold hands.
Anxiety includes panic attacks, which are discrete periods of intense terror to the point where the individual can’t catch his breath, or stop his heart from pounding, or control his fear of dying, or going crazy. Specific phobias include such things as fear of spiders or heights. Agoraphobia is the fear of being in certain places, like the outdoors. Social phobics are people who are anxious about performing or even speaking in public. Obsessive-compulsives are those anxious people who control their fears by thinking about something over and over again, or by carrying out compulsions, like excessive hand-washing. Patients with post-traumatic stress disorder (PTSD) re-experience the traumas to which they were subjected, such as the attacks on Sept. 11, a rape, or a robbery.
Anxiety is due to genetics and environment. If your parents had panic disorder, you may inherit it and have panic attacks, too. PTSD is caused by the environment and a genetic susceptibility. If a woman escaped the twin towers on 9/11, she likely has or had PTSD, especially if others in her family suffered post-traumatic stress disorder. This person may tell herself that it’s 2018 and the problem occurred in 2001, but that won’t stop her brain from producing nightmares and worries. A mind with PTSD will repeat the trauma until it’s worked through and resolved.
Psychiatrists reduce patients’ anxieties with many kinds of psychotherapy and medications. Psychotherapy is known as “talk therapy,” and it was created by Sigmund Freud in the late 1800s. Newer methods include cognitive behavioral therapy, a form of behavioral therapy that concentrates on thought processes to identify and change negative patterns of behavior. There is group therapy, couples therapy, individual therapy. Researchers have found that patients’ brain structures actually change when they are relieved of anxiety. Medications serve the same purpose, and can have provide faster relief than psychotherapy. Medications used for anxiety include Valium, Klonopin, Ativan, Zoloft, Lexapro, and others. Medicines are effective, but they can cause unwanted side effects such as addiction, sleepiness, and weight gain.
Psychiatrists are searching for more ways to help patients with anxiety. The present treatments work for panic disorder very well, but other anxieties, like generalized anxiety disorder, PTSD, obsessive-compulsive disorder, and certain phobias, are notoriously difficult to treat. Alternative methods of treatment presently include exercise programs, acupuncture, yoga, brain education, and pilates. Anxiety is not always bad. In small doses, it can keep us out of unwanted situations, or help motivate us to prepare for the future. But persistent anxiety can interfere with our lives — and is more common than you might think. Thankfully, help is out there.
Dr. Carol W. Berman is a psychiatrist who is a clinical instructor in psychiatry at NYU Medical Center. She is in private practice in New York City. Her two books, “One Hundred Questions and Answers About Panic Disorder” and “Personality Disorders: A Practical Guide,” explain further details about dealing with anxiety and other psychiatric conditions.