Anxiety

ANXIETY DISORDERS: Among the most prevalent psychological problems seen by mental health professionals and are known to be a major component of many medical conditions as well. These disorders (described below) are Generalized Anxiety Disorder, Simple Phobia, Social Phobia, Panic Disorder, Agoraphobia, Obsessive-Compulsive Disorder (OCD) and Post Traumatic Stress Disorder. Fortunately, successful psychological treatments are available for Anxiety Disorders. These include (among others) relaxation. Untreated, anxiety can have a profound impact on your ability to work, socialize, travel and generally cope with the demands of everyday living. Frequently, people with a fear of one object or situation wind up being apprehensive in a wider variety of circumstances unless they do something about their anxiety. People experiencing Anxiety Disorders are often misunderstood by well-meaning friends and family members who advise them to “just get over it” or “just stop thinking about it”. Anxiety sufferers very often report that they cannot get others to really understand just how severe their nervousness, fear, apprehension and physical symptoms are.
GENERALIZED ANXIETY DISORDERS: Unrealistic or excessive anxiety or worry about several life circumstances which persists for six months or longer and is accompanied by a some physical symptoms (shaking, sweating, dizziness, light-headedness, etc.).

SIMPLE PHOBIA: A persistent fear of a specific object or situation. Exposure to the specific phobic stimuli provokes an immediate anxiety response. Examples; fear of flying, of snakes or of closed spaces.
AGORAPHOBIA: The fear of having a panic or anxiety attack, primarily when outdoors or in large, open spaces. Panic attacks often occur in busy or loud places, and the underlying fear is of harm, loosing control, or being unsafe. Untreated, this disorder can result in people being housebound.

OBSESSIVE COMPULSIVE DISORDER (OCD): The development of unwanted, repetitive thoughts and/or compulsive behaviors that may develop into elaborate rituals. The behaviors can be time consuming and interfere with normal functioning. Examples: persistent hand-washing, checking light switches or door locks repeatedly or feeling a need to count certain objects over and over.

POST-TRAUMATIC STRESS DISORDER (PTSD)

SOCIAL PHOBIA: A persistent, irrational fear of and a compelling desire to avoid scrutiny by other people.
PANIC DISORDER: A sudden, intense and overwhelming sense of terror which occurs for no apparent reason. These feelings are accompanied by disturbing physical sensations and catastrophic thoughts about loss of control; a heart attack or even death.

ABOUT STRESS…
Stress is the most frequently reported health problem in the United States. Stress causes physical complications, such as hypertension, cardiac difficulty, and headaches. Stress can prevent us from performing effectively, distracts us from our goals, and is known to directly cause or be a major component in Asthma, High Blood Pressure, Hypertension, Backache, Acne, Lowered Resistance, Digestive Problems, Hair Loss (in patches), Fatigue, Headaches, Stomach Aches, Migraines, Heart Disease, Muscle Aches, and Blurred Vision.) In some circumstances, prolonged stress can be fatal! The good news is: You can do something about it! Stress-related emotional and physical problems are among the most preventable.

There are dozens of words we often use to describe stress: “Stressed Out”, “Wired”, “Burnt Out”, “Tense”, “Under Pressure”, “Strained”. Like an outside force, stress begins with demands placed on us by our environment. Stress becomes a serious problem only when the demands in our life overwhelm our ability to effectively cope. In some cases, we increase stress by adding our own unreasonable demands to the expectations already placed upon us.

Although there is a certain degree of overlap in definitions, stress can be differentiated from anxiety by looking at their respective sources: Stress begins with an outside source of excessive demands while anxiety is a fear or nervousness originating from inside of us (when there is no actual danger).
It is no surprise that we are surrounded by stress. Stress comes from everyday life. Living in the (soon to be) 21st century is stressful! If you think about the sources of stress in your life, you are likely to focus on your job, your family, romantic relationships, parenting, the economy, traffic, deadlines, etc. What is it about these situations and interactions that produces stress?

• Underlying many everyday life events are “Stress Points”: Circumstances and conditions which specifically increase our level of stress by placing demand on our capacity to cope. Think about a specific source of stress in your life and consider if any of the following underlying demands are present:
• Time Pressure (demands to perform work within specific time limits)
• Ambiguity (not knowing what’s expected, vague demands, unpredictable outcomes)
• Intellectual Demands (requirements to use cognitive skills and problem solving)
• Multiple Roles (having to switch roles, “change hats”, or be different things to different people: “mother”, “wife”, “employee”, best friend”)
• Responsibility (having to take action effecting the lives of others)
• Decision Making (making many, complex decisions without adequate time to think)
• Pressure to Perform (meeting other peoples unreasonable expectations for your work)
• Attention (having to attend to or focus on something for extended periods of time: air traffic controllers or security guards)
• Simultaneous Tasks (the requirement to do two or more things at the same time)
• Over-Stimulation (too much activity or sensory input in the environment)
• Noise (periodic, loud or distracting sounds)
• Pollution (smoke, fumes, odors, garbage, dirt, and litter )
• Crowding (lack of personal space, being in very close proximity)
• Lack of Quality (low quality materials, products not working to expectations, others who do not care about their work or personal life)
• Loss (loss of abilities, loss of a possession, loss of friendship or love)
• Expectations (predicting outcomes which do not occur as planned)
• Change (modification or change in some important aspect of life)
• Becoming aware of the underlying sources of stress in your life is a good start in coping more effectively. Any of the suggestions on anxiety found at this website can be applied to stress as well.

This is, as far as I have been able to determine, the World Wide Web’s most extensive list of clinically recognized phobias. This list may take a few moments to download because it is hundreds of items long. If you can supply other clinically recognized phobias to add to this list, please contact me. Please cite a reference for any new phobias you submit.
Thank you!
– Dr. Fred

ONE Be aware of any recent, significant changes in your life. Change is always a source of stress and anxiety. Even positive events, such as receiving a raise, going on vacation, or planning a social event can be very stressful. Don’t do too much at one time. Take on manageable projects, don’t spread yourself too thin, and learn to say no when you feel under pressure (read the advice on assertiveness at this website). If you are going through a stressful transition (a breakup in a relationship, moving, changing jobs, beginning formal education, beginning a diet, etc.) try not to take on any additional, unnecessary responsibilities.

TWO Eliminate “StressThink”. Very often it is the things we say to ourselves that make a situation unnecessarily stressful. These “self-statements” or irrational beliefs can be quite instrumental in increasing stress and anxiety, lowering attention span, and distracting us from achieving our goals. You may find some of the beliefs presented here to be very difficult to let go of, but you also may realize that holding to them is self-defeating and may place stressful demands on both you and people you associate with. It is a GOOD idea to have high standards, ethical concerns about the world, and lofty goals. It is not such a good idea to demand everything at once, expect others to always agree with you, or assume that you will be successful at all things. Be particularly aware of using extreme expressions such as “must”, “always”, “have to”, and “terrible” or “disastrous”. Here are some common StressThinks, with some alternative ways of viewing events:

I must be loved and approved by every significant person in my life, and if I’m not, it’s terrible. (It would be more productive to concentrate on self-respect, on winning approval for practical purposes, and on loving instead of being loved.)

I should be very anxious about events that are uncertain or potentially dangerous. (It would be better to face the danger or fear and render it non-dangerous, and when that is impossible, accept the inevitable. Worrying will usually not help, but action will.)

I am not worthwhile unless I am thoroughly competent, adequate, and achieving at all times, or at least most of the time in at least one major area. (It is more advisable to accept oneself as an imperfect creature with human limitations and fallibility’s. It is better to DO than to need to do well.)

The world should be fair and just. (The world is often unfair, and good guys sometimes do finish last. It is better to accept this fact and concentrate on enjoying oneself despite it.)

I should be comfortable and without pain at all times. (There’s seldom gain without pain. I can tolerate this discomfort, although I may never like it.)

Stress comes from external pressure, and I have little ability to control or change my feelings. Other people can really ruin my day. (Distress is largely caused by the view one takes of conditions. You have enormous control over your destructive emotions if you choose to work at believing that feelings are not “caused” by others, they are a reaction from you.)

My past is the cause of my present problems; because these events were strong influences on me, they will continue to be so. (One can learn from past experiences while not being overly attached to or prejudiced by them. The past has an influence, but it does not control you.)

“StressThink” puts pressure on us to perform, gives us unrealistic expectations, and distorts our view of the events and interpersonal relationships around us. Take some time to examine the thoughts, beliefs, and the things you say to yourself that actually increase anxiety. Try to practice alternatives to your stressful thoughts. It may be a good idea to have someone who knows you well help in this section. They may be more “objective” and less caught up in the emotions of the situation.

THREE Learn to use coping statements. Coping statements are things we say to ourselves when we are in difficult situations (similar to, but more specific than, “positive affirmations”). Coping statements are designed to replace irrational or stress producing notions that we almost automatically use. If you find yourself becoming stressful over something, refer to this list and read the statements to yourself. You may find it helpful to add your own personal coping statements to this list. Some people find it useful to keep a “cope card” in their wallet with “top ten” list of coping statements.

FOUR The next few items are part of a comprehensive program of relaxation. The first step is to learn to use paced breathing techniques. It is just another way to distract you from the usual stressful ideas (like, “What do I have to do tomorrow?” or “I should have accomplished more today”). Focusing should be done while you are visualizing your relaxation scene (see next section). The combination of visualization and focusing will help you disregard stress producing thoughts.

When we are anxious or stressful, our breathing becomes shallow and irregular. Practice keeping your breathing evenly paced. Concentrate on each breath as you breathe in and out. Choose a neutral word to focus on while practicing relaxation and visualization. The word “one”, “calm” or “relax” work well. Each time you breathe out, say this word to yourself. This will assist in keeping your breathing evenly paced and help reduce the chances of interfering stressful thoughts. Continue to say the word “one” with each exhale throughout the next few relaxation exercises.

FIVE Learn to use visualization by developing a personal relaxation scene.
Visualization is an important step in easing tension. The first step is to create a “relaxation scene”. The scene can be based on a real experience (such as a vacation resort, beach, or walk in the forest), or it can be totally made up. Think back to a place and time where you were almost totally relaxed. Think of a vacation, walking in a forest, tanning at the beach, looking out over a lake, or just sitting in your backyard watching the trees grow. If you choose an event like a vacation, be sure to dig up some photographs to remind yourself of exactly what the scene looked like. Pick one particular scene or event and stick to it. Be as specific and detailed as possible. Real experiences and memories usually work better, but feel free to embellish and fantasize. Try to be alone within your relaxation scene (this time it’s personal!). Some examples:

“I am rowing a wooden boat, alone, on a small lake in upstate New York. It is the middle of July. I can hear a waterfall in the distance and the gentle splash of the weathered oars entering the water. I look out over the glassy water and notice a lone, graceful bird skimming the surface. The trees are dark green, and bent over with the weight of a recent rain.”

“I’m lying on a beach at sunset. It is the beginning of summer vacation from school. There isn’t a cloud in the sky. The waves break in white splashes against a background of the orange and pink sky. The warm wind rushes through my hair as I look up at the darkening, blue sky.”

“Walking slowly through the Botanical Gardens and stopping at each bed of flowers. Looking out across the blooms, I can smell the leaves on the path in front of me: A very earthy, natural fragrance.”

“I am sitting on a flat rock overlooking a waterfall in a forest area of New Hampshire. I am at least 200 miles away from anyone I know. As I look at the tree-line of the distant mountain peaks, I begin to forget about my job and the classes at the college.”

Once you have found a specific relaxation scene, use your senses and make the scene more vivid. The idea is to occupy your mind so you are unable to think about anything else (like stress producing ideas). Take a good “look” at the relaxation scene in your mind. Imagine the colors in the sky. Are there any clouds? What do they look like? Think of the different shades of green in the trees and in the grass. What does the water look like? Think of the details: birds, animals, waves, colors, textures, sizes, shapes. Use photographs, if possible, to remind yourself. The more visual details, the better. Don’t forget to use your imaginary senses of hearing (imagine the sounds in your scene), smell, touch, etc.

The only thing left to do is bring the scene to life. Make it a moving picture, not a snapshot. Make the waves roll, the birds fly, and the clouds slowly change shape. Look around. Take a walk. Pick a flower. Remember that you are trying to give yourself a break.

Practice creating your personal relaxation scene for five minutes each day. Do it with your eyes closed, in a comfortable atmosphere, at a time when you will not be interrupted. Try to make the scene as vivid as possible. In just a short time, you will probably be able to clearly visualize the scene almost any time you feel tense. Don’t worry if you are having difficulty visualizing at first. The following muscle relaxation techniques will work even if you have trouble visualizing. By the way, if you fall asleep while practicing: It worked!

SIX This next step seems obvious, but it’s the most difficult to do! Allow yourself some time to relax every day. Find a room which is relatively quiet. If possible, with no phone or television in the room. Make sure that you will not be interrupted for awhile. If necessary, take the telephone off the hook. Ask family members to leave you alone. Adjust the heat, windows, shades or air conditioning for maximum comfort. Take anything (or anyone) that makes noise out of the room. Think of this as time you are allowing yourself to do something healthy. Sit in a chair, or lie down in a bed that is as comfortable as possible. A reclining position is best. Wear loose clothing, take your shoes and glasses off.

SEVEN Learn and practice progressive muscle relation techniques. Of all the advice on this page, this is the most important in controlling anxiety. The basic muscle relaxation techniques are intended to allow you to physically relax. Muscle groups are arranged in opposing pairs of “flexors” and “tensors”. For each muscle group, you will alternately tighten one muscle in each pair, relax, then tighten the other muscle in the pair. Through the exercises, you should become familiar with what it feels like for your muscles to be tense, and how it feels for them to be relaxed. The idea is to become more aware of when your muscles begin to get stiff (as a result of stress or anxiety). Eventually, with just a bit of practice, you will be able to “instantly” physically relax in stressful situations. The complete relaxation technique (available for purchase through this web page) involves almost all of your muscle groups. The one presented here is an abbreviated version.) You may want to practice for ten minutes just before you go to sleep. Relaxation is a skill – it has to be practiced!

Remember to find a comfortable atmosphere, use a personal relaxation scene, and pace your breathing. All of these procedures can be done simultaneously so that you are too occupied to be stressful! Although the tensing and flexing in these exercises should ideally be done to the point of moderate discomfort, don’t push yourself. Previous injuries or other medical conditions may limit you ability to apply stress to certain muscle groups.

Don’t put pressure on yourself to relax perfectly. Relaxation is a skill which has to be learned and practiced. If you find yourself to be somewhat nervous or tense during these exercises, don’t worry – just remain as relaxed as possible. If unpleasant or anxious thoughts enter your mind (“What do I have to do tomorrow?”, “What should I have accomplished today?”, “I have to have the car looked at.”, etc.), just try to push them out as best as possible for now. The first few times you practice relaxing, your goal should be to feel just a little more relaxed than when you start. You will probably feel more and more relaxed with practice.

EIGHT Use the Worst Case Scenario technique. If your stress producing thoughts are about anticipation over an upcoming event (like deciding to ask for a raise, finally confronting your friend about an annoying habit, or apprehension about attending a social function) try imagining what could happen if everything went TOTALLY wrong! What would happen in the absolute WORST case? Imagine all the details of everything going wrong. Try exaggerating the worst case to the point of absurdity. For example, imagine asking for a 5% raise after working in the same firm for three years. What’s the worst that can happen? Visualize everything going wrong at once. Since your real life situation is not likely to turn out quite this badly, this exercise does two things: Prepares you for possible failure and gets you to realize that maybe you ARE worrying too much. As Alice said after her extensive fall down the rabbit hole: “After such a fall as this, I shall think nothing of tumbling down stairs!”

NINE Stay healthy. Try to maintain good nutrition, even when you are rushed and busy. Try eating smaller meals more often during the day. Take diet supplements, such as vitamins, if you don’t eat right. Get a reasonable amount of exercise (walking, aerobics, bowling, golf, even window-shopping) and stay current with medical checkups. Get enough sleep, and try to keep your sleeping patterns regular. As a general rule, stay away from foods containing caffeine, especially after 6:00 p.m. (coffee, tea, cola, chocolate, certain cakes and cookies,etc.) Physical well-being is directly related to mental health.

TEN Give yourself reinforcement after you have successfully tried one of the techniques described above, even if the outcome was not exactly what you wanted. Relaxation is a skill which needs to be practiced. It is very important to be “self-rewarding”. It encourages you to try again and protects you from being overly effected by situations out of your control. Rewards do not have to be monetary. Try listening to a favorite CD, playing a game, taking a long private bath, or calling a long-distance friend.

MORE quick advice on reducing stress and anxiety:

Develop a sense of the ridiculous. Learn to laugh at yourself and at most of life’s difficulties. Humor destroys stress.

Discuss rather than argue. Walk way from some unnecessary fights and disagreements. Realize that not everything can be settled.

Don’t confuse what you do with who you are.

Put things in the right perspective. It may be important today, but who will care five years from now?

Learn to daydream and fantasize occasionally. Visualize a successful future (while your visualizing world peace!). Tomorrow’s dream takes the stress out of today’s burdens.

Use your social supports. Talk about your problems, tensions, and concerns. Your friends want to be helpful, and need to know it is OK for THEM to vent, too! Get a pet if people won’t listen.

Don’t compete with everyone all the time. Don’t compare yourself with others, only with realistic standards you’ve set for yourself.

Break your routine. Explore a neglected room of the house. Look through old photographs. Visit a neighbor. Draw something! Volunteer at a hospital. Take time every day to relax, meditate, and be alone.

Here is some more lighthearted advice for people on a diet:

THERAPY
Don’t let stress or anxiety limit your life! If you have tried all the techniques presented here, but remain stressful, anxious, overly worried, depressed, or nervous: Help IS available. The author conducts individual therapy for stress and anxiety, stress reduction groups, and therapy through this website. If you believe you are experiencing a great deal of stress and anxiety, or have some of the physical consequences of stress discussed here, you may want to consider individual therapy. Therapy can assist you in identifying sources of stress, reducing stress in your environment, coping effectively, and learning how to physically relax. There are many more techniques to reduce anxiety and deal with panic attacks than are listed on these pages. If you have any questions about the material on this page, or questions about coping with stress in general, please feel free to contact Fred L. Holtz, Ph.D.
Use the menu above or click to learn about Anxiety Disorders and see the web’s most extensive List of Phobias!