Therapy & Medication for Anxiety
What is Anxiety?
Most of us have experienced a sleepless night before a big test, nervous jitters before public speaking, or unease while we wait for a medical test. These are examples of anxiety, or a sensation of fear arising from the unknown, or of a perceived threatening event. Anxiety is among the spectrum of normal human emotions, but when it becomes pervasive it can disrupt our everyday life. At The Midtown Practice, our experienced clinicians can help you identify and cope with anxiety when it becomes overwhelming and teach you tools to help you reach your goals and embrace what you value most in life. We work with children, adolescents, and adults to manage anxiety.
The Evolutionary Aspect of Anxiety
Thousands of years ago, when our ancestors were wandering the plains or the tundra, they were outnumbered by prey and predators who were faster, stronger, had sharper teeth, a keener sense of smell, and even more perceptive hearing. The one advantage our predecessors had was a larger brain, with the ability to anticipate the future. In order to survive we learned to essentially overestimate the potential dangers in our environment. Consider the following example: two australopithicus africanis were walking together and saw a shadowy figure in the periphery. One thought it was a rock, the other thought it was a lion, and instantly fled the scene. Which one do you think was more likely to survive? It is easy to see how overestimating dangers became integral to our survival. Those that were able to flee the lion (or rock in some cases!) actually lived longer and reproduced. Humans today are the descendants of these ancient worriers. As you can see, we are all unfortunately prone to exaggerate worst case scenarios and disproportionately weigh negative alternatives. The clinicians at The Midtown Practice recognize that while our biology primes us towards anxiety, many suffer from too much worry and doubt.
The Biological Basis of Anxiety
Many of us understand what it feels like to be anxious, but what happens in our body to create the feelings of nervousness? The sensation of anxiety is produced by a well studied neural circuit known as the sympathetic nervous system. When we perceive a threat in our environment, an ancient nucleus in our brain, the amygdala, is activated. The amygdala receives input from more sophisticated areas of our brain such as the prefrontal cortex, as well as directly from the five sense organs: the eyes, ears, nose, taste, and touch. Unfortunately, the process does not distinguish between a real or imagined threat, and our body and brain prepares for the worst. The amygdala sends diffuse projections throughout the brain, activating the sympathetic nervous system (SNS) and heightening fearful emotions. The SNS directs the adrenal glands to release epinephrine, norepinephrine, and cortisol. These hormones are responsible for producing a range of physical sensations associated with anxiety.
Taken together, the hormones and neurotransmitters released in response to the activation of the sympathetic nervous system cause a predictable cascade of events. First, thinking becomes more concrete. Sophisticated problem solving becomes difficult as we jump to worst case scenarios. We tend to see the world in black and white terms such as good or bad, dangerous or safe. We also feel physical changes and sensations in our body. Since our nervous system is unable to differentiate between physical and emotional threats, it signals our body for a threat to our survival by preparing us to flee from a danger or predator. Our heart beats faster in order to increase blood flow to our limbs, our breathing becomes more rapid to deliver oxygen to our muscles. We might feel like we need to rush to bathroom as our body signals our digestive system to slow down and empty our bowels and bladder in order to make ourselves lighter on our feet. We begin to perspire, and we even lose our peripheral vision in order to diminish distractions to flee from a perceived predator.
Unlike our ancestors, in most urban areas such as New York City, we are not running from our enemies, but instead wrangling with how to handle a difficult boss, balance or juggle responsibilities, or manage other difficult but not life threatening situations. At the Midtown Practice, we help our clients identify our body’s outdated responses to stress and help replace this tendency with practical and adaptive strategies to handle our difficulties.
Types of Anxiety Disorders
Anxiety disorders are amongst the most common psychological disorders, affecting as much as 30% of the American population. There are several types of anxiety disorders, such as Generalized Anxiety Disorder, Panic Disorder, specific phobias, agoraphobia, and social anxiety. Each of these disorders has a specific constellation of symptoms. For example, Generalized anxiety disorder is marked by persistent and exaggerated worry about a number of things. This pervasive worry is out of proportion to actual events. Panic disorder is marked by severe and sudden episodes of physical anxiety that often arise without warning. Those with panic disorder suffer from these disruptive attacks as well as the fear of having additional panic attacks. Specific phobias are intense, irrational fears of something that poses little or no actual danger. Examples can be flying in airplanes, driving, or insects. Although individuals suffering from phobias recognize that their fear is irrational, they cannot prevent their severe anxiety. Agoraphobia is persistent avoidance of places that produce feelings of entrapment, helplessness, or produce panic. These places are typically innocuous, such as public transportation, theater events, or classrooms. Social anxiety is marked by worry that arises from everyday social interactions and is particularly destructive to relationships and quality of life.
Worry and fear are normal human emotions, but when these cause undue distress or become pervasive and interfere with our relationships, professional aspirations, and normal activities, it is important to seek help. Our skillful clinicians at The Midtown Practice can help you gain more understanding of your anxiety. We can also help you choose the most appropriate treatment and lifestyle modifications that will enable you to enhance your functioning and develop a more grounded and stable peace of mind.