PSYCHOLOGICAL COUNSELING CENTER
for Cognitive Behavior Therapy
KIM DONG-KYUN NEURO-CLINIC

Anxiety

Anxiety is your body’s natural response to stress. It’s a feeling of fear or apprehension about what’s to come. The first day of school, going to a job interview, or giving a speech may cause most people to feel fearful and nervous. But if your feelings of anxiety are extreme, last for longer than six months, and are interfering with your life, you may have an anxiety disorder.

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It’s normal to feel anxious about moving to a new place, starting a new job, or taking a test. This type of anxiety is unpleasant, but it may motivate you to work harder and to do a better job. Ordinary anxiety is a feeling that comes and goes, but does not interfere with your everyday life.

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In the case of an anxiety disorder, the feeling of fear may be with you all the time. It is intense and sometimes debilitating. This type of anxiety may cause you to stop doing things you enjoy. In extreme cases, it may prevent you from entering an elevator, crossing the street, or even leaving your home. If left untreated, the anxiety will keep getting worse.

Anxiety disorders are the most common form of emotional disorder and can affect anyone at any age. According to the American Psychiatric Association, women are more likely than men to be diagnosed with an anxiety disorder.

Anxiety is a key part of several different disorders. These include:

• Feeling restless, wound-up, or on-edgepanic disorder - experiencing recurring panic attacks at unexpected times. A person with panic disorder may live in fear of the next panic attack.

• phobia - excessive fear of a specific object, situation, or activity

• social anxiety disorder - extreme fear of being judged by others in social situations

• obsessive-compulsive disorder - recurring irrational thoughts that lead you to perform specific, repeated behaviors

• separation anxiety disorder - fear of being away from home or loved ones

• illness anxiety disorder - anxiety about your health (formerly called hypochondria)

• post-traumatic stress disorder (PTSD) - anxiety following a traumatic event

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Anxiety feels different depending on the person experiencing it. Feelings can range from butterflies in your stomach to a racing heart. You might feel out of control, like there’s a disconnect between your mind and body. Other ways people experience anxiety include nightmares, panic attacks, and painful thoughts or memories that you can’t control. You may have a general feeling of fear and worry, or you may fear a specific place or event.

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Symptoms of general anxiety include:​

• increased heart rate

• rapid breathing

• restlessness

• trouble concentrating

• difficulty falling asleep

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Your anxiety symptoms might be totally different from someone else’s. That’s why it’s important to know all the ways anxiety can present itself. Read about the many types of anxiety symptoms you might experience.

Once you’ve been diagnosed with anxiety, you can to explore treatment options with your psychotherapist. For some people, medical treatment isn’t necessary. Lifestyle changes may be enough to cope with the symptoms. In moderate or severe cases, however, treatment can help you overcome the symptoms and lead a more manageable day-to-day life.

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Treatment for anxiety falls into two categories: psychotherapy and medication. Meeting with a therapist or psychologist can help you learn tools to use and strategies to cope with anxiety when it occurs. Medications typically used to treat anxiety include antidepressants and sedatives. They work to balance brain chemistry, prevent episodes of anxiety, and ward off the most severe symptoms of the disorder.

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Lifestyle changes can be an effective way to relive some of the stress and anxiety you may cope with every day. Most of the natural “remedies” consist of caring for your body, participating in healthy activities, and eliminating unhealthy ones. These include:

• getting enough sleep

• meditating

• staying active and exercising

• eating a healthy diet

• staying active and working out

• avoiding alcohol

• avoiding caffeine

• quitting smoking cigarettes

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If these lifestyle changes seem like a positive way to help you eliminate some anxiety, think about how each one works - plus, get more great ideas for treating anxiety. Anxiety is natural and common in humans. In fact, one in eight will experience anxiety. But, uncontrolled anxiety may begin to interfere with daily activities, and may avoid interacting with their peers or family members. Anxiety treatment includes cognitive behavioral therapy (talk therapy) and medications.

Stress and anxiety are two sides of the same coin. Stress is the result of demands on your brain or body. It can be the caused by an event or activity that makes you nervous or worrisome. Anxiety is that same worry, fear, or unease.

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Anxiety can be a reaction to your stress, but it can also occur in people who have no obvious stressors. Both anxiety and stress cause physical and mental symptoms.

Symptoms of an anxiety disorder might include:

• headache

• stomachache

• fast heartbeat

• sweating

• dizziness

• jitteriness

• muscle tension

• rapid breathing

• panic

• nervousness

• difficulty concentrating

• irrational anger or irritability

• restlessness

• sleeplessness

• feelings of fear

• shame

• feelings of isolation

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​Neither stress nor anxiety is always bad. Both can actually provide you with a bit of a boost or incentive to accomplish the task or challenge before you. However, if they become persistent, they can begin to interfere with your daily life. In that case, it’s important to seek treatment.

Depression (major depressive disorder) is a common and serious medical illness that negatively affects how you feel, the way you think and how you act. Fortunately, it is also treatable. Depression causes feelings of sadness and/or a loss of interest in activities you once enjoyed. It can lead to a variety of emotional and physical problems and can decrease your ability to function at work and at home.

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Although depression may occur only once during your life, people typically have multiple episodes. During these episodes, symptoms occur most of the day, nearly every day and may include:

• Feelings of sadness, tearfulness, emptiness or hopelessness

• Angry outbursts, irritability or frustration, even over small matters

• Loss of interest or pleasure in most or all normal activities, such as sex, hobbies or sports

• Sleep disturbances, including insomnia or sleeping too much

• Tiredness and lack of energy, so even small tasks take extra effort

• Reduced appetite and weight loss or increased cravings for food and weight gain

• Anxiety, agitation or restlessness

• Slowed thinking, speaking or body movements

• Feelings of worthlessness or guilt, fixating on past failures or self-blame

• Trouble thinking, concentrating, making decisions and remembering things

• Frequent or recurrent thoughts of death, suicidal thoughts, suicide attempts or suicide

• Unexplained physical problems, such as back pain or headaches

For many people with depression, symptoms usually are severe enough to cause noticeable problems in day-to-day activities, such as work, school, social activities or relationships with others. Some people may feel generally miserable or unhappy without really knowing why.

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Symptoms must last at least two weeks and must represent a change in your previous level of functioning for a diagnosis of depression.

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Also, medical conditions (e.g., thyroid problems, a brain tumor or vitamin deficiency) can mimic symptoms of depression so it is important to rule out general medical causes.

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Depression affects an estimated one in 15 adults (6.7%) in any given year. And one in six people (16.6%) will experience depression at some time in their life. Depression can occur at any time, but on average, first appears during the late teens to mid-20s. Women are more likely than men to experience depression. Some studies show that one-third of women will experience a major depressive episode in their lifetime. There is a high degree of heritability (approximately 40%) when first-degree relatives (parents/children/siblings) have depression.

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The death of a loved one, loss of a job or the ending of a relationship are difficult experiences for a person to endure. It is normal for feelings of sadness or grief to develop in response to such situations. Those experiencing loss often might describe themselves as being “depressed.”

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But being sad is not the same as having depression. The grieving process is natural and unique to each individual and shares some of the same features of depression. Both grief and depression may involve intense sadness and withdrawal from usual activities. They are also different in important ways:

• In grief, painful feelings come in waves, often intermixed with positive memories of the deceased. In major depression, mood and/or interest (pleasure) are decreased for most of two weeks.

• In grief, self-esteem is usually maintained. In major depression, feelings of worthlessness and self-loathing are common.

• In grief, thoughts of death may surface when thinking of or fantasizing about “joining” the deceased loved one. In major depression, thoughts are focused on ending one’s life due to feeling worthless or undeserving of living or being unable to cope with the pain of depression.

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Grief and depression can co-exist For some people, the death of a loved one, losing a job or being a victim of a physical assault or a major disaster can lead to depression. When grief and depression co-occur, the grief is more severe and lasts longer than grief without depression.

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Distinguishing between grief and depression is important and can assist people in getting the help, support or treatment they need.

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Depression can affect anyone - even a person who appears to live in relatively ideal circumstances. Several factors can play a role in depression:

• Biochemistry - Differences in certain chemicals in the brain may contribute to symptoms of depression.

• Genetics - Depression can run in families. For example, if one identical twin has depression, the other has a 70 percent chance of having the illness sometime in life.

• Personality - People with low self-esteem, who are easily overwhelmed by stress, or who are generally pessimistic appear to be more likely to experience depression.

• Environmental factors - Continuous exposure to violence, neglect, abuse or poverty may make some people more vulnerable to depression.

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Depression is among the most treatable of mental disorders. Between 80% and 90% percent of people with depression eventually respond well to treatment. Almost all patients gain some relief from their symptoms.

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Before a diagnosis or treatment, a health professional should conduct a thorough diagnostic evaluation, including an interview and a physical examination. In some cases, a blood test might be done to make sure the depression is not due to a medical condition like a thyroid problem or a vitamin deficiency (reversing the medical cause would alleviate the depression-like symptoms). The evaluation will identify specific symptoms and explore medical and family histories as well as cultural and environmental factors with the goal of arriving at a diagnosis and planning a course of action.

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Medication: Brain chemistry may contribute to an individual’s depression and may factor into their treatment. For this reason, antidepressants might be prescribed to help modify one’s brain chemistry. These medications are not sedatives, “uppers” or tranquilizers. They are not habit-forming. Generally antidepressant medications have no stimulating effect on people not experiencing depression.

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Antidepressants may produce some improvement within the first week or two of use yet full benefits may not be seen for two to three months. If a patient feels little or no improvement after several weeks, his or her psychiatrist can alter the dose of the medication or add or substitute another antidepressant. In some situations other psychotropic medications may be helpful. It is important to let your doctor know if a medication does not work or if you experience side effects.

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Psychiatrists usually recommend that patients continue to take medication for six or more months after the symptoms have improved. Longer-term maintenance treatment may be suggested to decrease the risk of future episodes for certain people at high risk.

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Psychotherapy: Psychotherapy, or “talk therapy,” is sometimes used alone for treatment of mild depression; for moderate to severe depression, psychotherapy is often used along with antidepressant medications. Cognitive behavioral therapy (CBT) has been found to be effective in treating depression. CBT is a form of therapy focused on the problem solving in the present. CBT helps a person to recognize distorted/negative thinking with the goal of changing thoughts and behaviors to respond to challenges in a more positive manner.

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Psychotherapy may involve only the individual, but it can include others. For example, family or couples therapy can help address issues within these close relationships. Group therapy brings people with similar illnesses together in a supportive environment, and can assist the participant to learn how others cope in similar situations .

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Depending on the severity of the depression, treatment can take a few weeks or much longer. In many cases, significant improvement can be made in 10 to 15 sessions.

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There are a number of things people can do to help reduce the symptoms of depression. For many people, regular exercise helps create positive feeling and improves mood. Getting enough quality sleep on a regular basis, eating a healthy diet and avoiding alcohol (a depressant) can also help reduce symptoms of depression.

Depression is a real illness and help is available. With proper diagnosis and treatment, the vast majority of people with depression will overcome it. If you are experiencing symptoms of depression, a first step is to see your family physician or psychiatrist. Talk about your concerns and request a thorough evaluation. This is a start to addressing your mental health needs.