This is the second entry in the discussion on anxiety and panic.

Before we can get to more practical issues, I need to define one more term. And that is: stress.

There are hosts of definitions for stress. The way in which I will use stress here is most nearly defined by The Free Dictionary. Their definition reads in part, “A mentally or emotionally disruptive or upsetting condition occurring in response to…external influences and capable of affecting physical health, usually characterized by increased heart rate, a rise in blood pressure, muscular tension…”

Note again, like fear, stress occurs in response to events or conditions in the world outside ourselves.

Importantly, the stressor, the outside event or condition, can be either good or bad thing. This was first discovered by Hans Selye. Getting married, an event that is usually very much desired, is a stressor. A meeting with your boss about more job duties for lower pay, a very unwanted situation, is also a stressor.

The experience of stress is less intense than anxiety, fear or panic. There is a world of difference between the situations where someone says “Man, this is stressing me out” and “Oh my God, I’m gonna die. Run!”

But the effects of having a panic or anxiety attack lowers your ability to handle the next stress that comes your way. The same is true if you go through a major stress or a number of lesser stresses. In this way, something that yesterday you might have handled easily might cause an anxiety attack today if you encountered a number of problems in the last 24 hours.

A degree of stress can be helpful. For instance, your wedding is coming up in a month and you still have not selected the wedding cake. The stress associated with that can arouse to you focus on the task and give you the energy to see it through to completion. If a sense of stress was missing, the wedding cake might never get bought.

But stress is a bit more complicated. For one, it is rare that there is only one stressor in a person’s life. While comparing wedding cakes, you might also be trying to impress your soon-to-be in-laws, and trying to stay within a budget and managing to meet all the normal daily demands on your time. The effects of these different stressors are cumulative. That is, the effects of the stress remain with us, adding one upon the other, until we do something to purge them.

And we have to take into account that one person’s stress threshold may be very different from the next person’s. Moreover, one person’s stress threshold can improve or decline over time.

Making matters more complicated, no stressor exists in a vacuum. There is also the person and his or her background to take into account. Buying a wedding cake may be a quite different experience for someone who is pregnant and has morning sickness versus one who is not.

Further, the person and the stressor occur within a social and cultural context that may decrease or increase the stress load. The wedding cake bought by a pregnant teen might be a very different stressor in settings tolerant of teen pregnancy versus a culture of intolerance for sex before marriage.

Hopefully, my point is getting clearer. Calculating the degree of stress someone is under is not a matter of simple math. One wedding cake = One unit of stress. That is just not the case. So, it makes little sense to think that another person “should just get over it. It was no big deal.”

This leads us to George L. Engel. He proposed a biopsychosocial model. As the name implies, it suggests that we have to include the biological or physical aspects of a person; the psychological context or meaning the stress or symptoms have for that person; and the social context in which the person lives.

For our purposes, the take home points of the biopsychosocial model are that stress is the particular effect, mentally and physically, an external event has on a unique individual at a particular point in time within a given social setting.

Remember also that stress levels can build up over time. As stresses increase on a person, it can lead to a worsening situation that might include anxiety, panic, physical illness or other problems.

Treatment strategies have to take all of this into account. That cannot happen with a cookie-cutter or one treatment fits all approach. The type of treatment provided, the style of the therapeutic relationship and other aspects of therapy have to take into account the biopsychosocial status of the person seeking treatment.

Next time, we will consider some of the varieties of treatment available for anxiety and panic related disorders.

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Anxiety & Panic

[anxiety psychotherapy panic]

This is my first effort at a blog. So, it may take a while to get it right. I appreciate your patience and any comments or suggestions you may have are welcome. My hope is to get one installment on to the blog per week.

I will start by providing some educational material about some of the common problems that bring people into my office. Given the nature of blogs, I can neither answer questions about specific cases nor provide an exhaustive coverage of the topic. It is, after all, a blog and not a book. None of the information presented in this blog is a replacement or substitute for psychotherapy, diagnosis, or treatment by any professional. (Please refer to the privacy policies of my website for a fuller discussion of this matter.)

What’s In a Word?

Anxiety in one form or another is perhaps the most common problem for people in my practice.

One of the best starting points for the treatment of anxiety comes from the definition of anxiety. For such a common emotion, the Wikipedia definition is technical and stuffy. However, it still helps to make a clear distinction between anxiety and fear. They write: “Anxiety occurs unconnected to a specific identifiable external stimulus; as such it is distinguished from fear, which occurs in the presence of an identifiable threat.”

Now, let’s look at the history of those two words, anxiety and fear.

The Online Etymology Dictionary traces the original meanings of anxious and anxiety to “uneasy, troubled in mind” and “choke, cause distress,” “tightness, narrowness.”

Their history of the meaning of fear includes “danger, peril…harm…risk…”

All right, we have the definitions and their history. Now let’s see how they apply in practice.

Anxiety is a state of vigilance, being on alert, worrying that there is a looming problem. There is no clearly identified threat. We are troubled or worried about something hard to define or to put our hands on. For example, “I’m anxious because I heard a noise in the dark.” However, a noise in the night does not clearly identify any harm or risk.

Fear, as we found out above, is an emotion we have when confronted with a real, external danger. For example, “I am afraid of the growling, drooling dog that is coming toward me.” The danger and peril are clear-the rabid dog wants to bite me.

In day-to-day life, both anxiety and fear play important and necessary roles. Anxiety alerts us to the possibility of danger. Fear informs us about a clear and present threat.

When we are anxious, a host of biological processes kicks into gear. (In a later blog entry, I will deal more with the biological side of anxiety.) At the same time, our thoughts turn towards identifying potential threats. This is as it should be. Our internal warning systems engage when there is a vague but still potentially real risk to our welfare.

In anxiety, it is difficult if not impossible to plan a course of action. That holds true because we are still uncertain about what the real threat is. Without knowing the source and nature of the threat, we cannot make reliable plans for our protection and defense.

Actions based on anxiety are often regrettable. Perhaps you can recall reading about one of those instances where a parent hears a noise in the middle of the night. He or she grabs the bedside pistol and anxiously goes down to investigate. Hearing the noise again, the levels of anxiety rise and they pull the trigger. Thinking that they have defended the home against an intruder, they are shocked to learn they have shot one of the children.

In these cases, anxiety warns the parent of the possibility of danger. However, before fully determining if there really is any threat, they act blindly. It is important to see that anxiety itself can be the foe. It is crucial to hold back until verifying if there is anything to fear.

These tragic scenarios show us the real value in fear. Fear occurs when we can identify the threat. When we are fearful, we have a lot of energy and our thoughts focus solely on the threat. Now we can make plan to deal with the threat. When in fear, the who, what, when and where are known. The rabid dog is right now ten feet in front of me. Our job is to use fear to figure out how to deal with the dangerous situation.

Using the intruder in the night scenario, the anxious parent goes down the hallway and yells down the stairs “Who’s there; is that you Johnny?” The parent then turns on the light. If he or she sees little Johnny getting a glass of water, the anxiety vanishes with a sense of relief.

However, if it is a thief, anxiety turns to fear. The parent can now make and evaluate plans. Is it best to yell and order the thief out of the house? Is it better to use a cell phone to call the police? How would it work out to run back into the bedroom and lock the door? Is there no other option but to shoot?

Closely related to anxiety and fear is panic. Panic, according to the NIMH, is “characterized by a fear of certain disaster or a fear of losing control.” Someone panics when they judge that there is no escape from an overwhelming external threat. Alternatively, panic comes when someone no longer has a feeling of control over oneself. Panic abandons the attempt to reason or plan one’s way out of danger. The instinct to run or to freeze in place takes over. Like the old joke: When all else fails, Panic!

Panic has a valid role in survival. It is logical to run from an oncoming disaster. “Run, the house is on fire.” It can be just as logical to become immobile and play ‘possum. “Shh! Don’t move and he won’t see us hiding here.”

Anxiety, fear and panic in the right context are healthy and adaptive responses. They become reasons to enter into psychotherapy when they occur without apparent reason or in situations where they don’t belong.

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