Ask Dr. Barb: Anxiety treatment requires understanding its cause

Dr. Barbara Rosenberg

Dear Dr. Barb:

My wife tells me that a friend is taking medication for anxiety, and she wants to talk to our doctor about whether she needs to be on a similar program. I recently saw that there is even anxiety medicine for pets. I never knew that anxiety is a condition that requires medication. I always thought it was an emotional state that related to a certain situation that would eventually pass. My thoughts have been that feeling anxious is something that we all experience from time to time and learn to cope with. When did this change so that anxiety is now something that requires medication?

Dear Reader:

Anxiety is an emotional state in which one feels tense, apprehensive or uneasy in anticipation of something — even something unknown. Nearly everyone deals with anxiety from time to time. Stressful events like public speaking, job interviews or difficult life circumstances such as divorce, job loss or family illness can cause one to feel anxious or nervous.

In general, anxiety is caused by a combination of psychological, social and physiological factors. As an example, some individuals are prone to be anxious based on their genetic predispositions.The tendency to become anxious often can be passed down from one generation to the next. However, parental role models also can generationally transmit anxiety. For example, if a parent has a tendency to worry a lot, a child will grow up learning about everything there is to worry about. Also, when children grow up feeling psychologically neglected or unsupported, they develop feelings of anxiety and insecurity.

A state of anxiety, no matter what the causes, does not necessarily require a prescription for medication. For milder anxiety brought about by life’s normal stressors, using medication without understanding what is  causing anxious feelings can cause a person to become too dependent on medication. 

In order to cope with stress in a healthy way, one has to learn to regulate self-defeating emotions, not by numbing the feelings of distress, but by being mindful of them and thinking and acting in a way that brings about calmness. Recognizing a tendency to worry and to exaggerate potential danger or discomfort, without proven evidence that one will experience either, is a first step in  managing general states of anxiety.

For example, a shy person often experiences nervousness when interacting with others. In these situations, it would be better for that individual to accept feeling anxious as his or her typical reaction. Rather than trying to avoid feeling anxious due to the stressful challenge of socializing, the person can gradually learn to relax by practicing positive self-talk and developing conversational skills.

He or she also can learn to relax by lowering the initial feeling of nervousness rather than trying to eliminate it altogether. One can do this by measuring one’s anxiety on a scale of zero to ten. By thinking positively and taking relaxing breaths, the anxiety can be lowered from a ten to six, thereby allowing for a feeling of emotional control and less of a feeling of panic.

Through ongoing exposure to social situations rather than avoiding them, the individual will gradually develop better emotional regulation and further lower anxiety, perhaps to a level three, resulting in more self-confidence.

On the other hand, when anxiety interferes with effective living or prevents one from achieving desired or satisfying goals, it may become more serious in nature. In these situations, the level of frequency, duration and intensity of the anxiety can interfere with one’s ability to sleep, to concentrate, to eat and/or to socialize with others and ultimately may necessitate medication.

Nevertheless, even in these situations, when anxiety becomes so disabling in nature that medication may be indicated, it still is advisable to work on the underlying causes and to develop strategies that can reduce the level of anxiety.

In situations where an individual has experienced physical or mental trauma, it may be necessary to talk with a professional, such as a clinical psychologist, in addition to the psychiatrist who prescribes the necessary medication.

If a person has experienced physical assault or abuse, the psychologist, in a compassionate and supportive way, will talk through the traumatic memories, helping the victim to not assume responsibility or blame. 

The person also is taught to cope with anxiety reactions triggered by traumatic memories by using emotional self-regulation and various relaxation methods. When ready, he or she then can begin to gradually face situations that in some way resemble the original trauma. In doing so, the person can learn not to automatically anticipate danger if situations seem unclear and threatening.

A psychologist also can teach the person how to be assertive for self protection in future situations. In time, with learning healthy strategies and self-talk, he or she can feel em- powered and no longer like a helpless victim. With good coping mechanisms having been learned, the person can be slowly weaned off medication under the psychiatrist’s direction.

In general, there is no one-size-fits-all when learning to cope with anxiety. Even in some of the more serious conditions, such as those cited above, talk therapy alone without medication may be entirely helpful. One can even try other relaxation methods such as physical exercise, yoga or meditation together with talk therapy. However, when these approaches in and of themselves do not alleviate the distress, it would seem that medication indeed may be indicated.

Barbara L. Rosenberg, Ph.D, is a licensed psychologist whose Summit practice serves individuals of all ages, as well as couples and families. She previously chaired educational and social programs for the Essex-Union County Association of Psychologists. Contact her through BarbaraRosenberg.com.

Get more insights from Dr. Barb's columns by clicing here.