Treatment of Anxiety Disorders
Working with people of all ages having trouble with
panic attacks, phobias, obsessive compulsive disorders, social anxiety.
OCD | Panic Disorder | Phobias | Social Anxiety | Generalized Anxiety Disorder | Separation Anxiety
| Acute Stress Reaction | Post Traumatic Stress Disorder |

Anxiety happens to everyone. Sometimes it is helpful, such as in avoiding a car crash or motivating us to study for a test. But anxiety can become a problem if it keeps on happening when we are not in danger. Psychologists classify anxiety problems into “disorders”. These diagnoses help the doctor know what is mostly likely to help the anxiety sufferer. Among common anxiety disorders are:

Obsessive Compulsive Disorder: Also known as OCD, it is a very common type of anxiety problem, afflicting up to 2.5% of the population, (and even up to 10% if you include other related problems, like some eating disorders, compulsive gambling, somatization disorder, and body dysmorphic disorder.) I list it first because while I treat people with all types of anxiety, OCD is my true specialty. If you have OCD you suffer from either:

Obsessions - unwanted distressing thoughts, ideas, images, or impulses, that once they are in your head, are hard to get out of your head, and make you feel very anxious or distressed.


Compulsions - behavior or acts, including mental acts and avoidance behaviors, that you feel driven to perform to decrease your anxiety and distress.

If you have OCD, most likely you suffer from both obsessions and compulsions, which work hand in hand to create severe anxiety.

OCD is very, very treatable using behavior therapy. Simply put, behavior therapy for OCD is “Identify the compulsions, and eliminate them”. While this may sound simple, sometimes it is very difficult, because in not doing the compulsions people can get very, very anxious. Therefore I teach people tools for reducing the compulsions slowly, and techniques to better manage the anxiety. Finally, once you have gotten the compulsions under control as they naturally occur in your life, it is good to do some exposure therapy to those things that cause the obsessions and anxiety, and to intentionally not do the compulsions. This exposure and response prevention helps prevent relapses in the future.

Panic Disorder (with or without agoraphobia): Panic disorder is characterized by suffering from panic attacks, periods of extreme anxiety, which seem to come at first entirely out of the blue. Symptoms of a panic attack include:

Dizziness, light-headedness, faintness

Hot flushes or chills


Trembling or shaking

Numbness or tingling sensations, especially in the hands, feet, or around the mouth

Feeling of throat closing or gagging

Tightness, pain, or discomfort in the chest

Shortness of breath

Rapid or pounding heartbeat

Nausea or abdominal distress

Feeling like you’re having a heart attack and are about to die

Feeling like you are going crazy or losing control

Feeling like you are watching everything from far away

Feeling that things seem too vivid, or not vivid enough

All panic attacks do not come from panic disorder. In fact, most of the anxiety disorders can generate panic level anxiety.

In some cases people with panic disorder develop agoraphobia, or severe avoidance behaviors, which might lead them to become prisoners in their own homes, for fear that venturing out will trigger a panic attack.

Panic disorder is very treatable with cognitive behavioral therapy. First I teach people powerful tools to better manage and reduce their anxiety. As they use these tools in their everyday lives, anxiety becomes less intense and less frequent. I also teach people cognitive therapy techniques to learn to see the world as a less dangerous place. Finally, in cases where significant avoidance behaviors have developed, I teach people how to do “in vivo”, or real life, exposure therapy to actively confront their fears by intentionally doing the things they have been avoiding doing.

Phobias: Phobias are irrational fears of specific situations, such as flying in an airplane, going on an elevator, and being in a high place. People can develop phobias about almost anything, including animals, colors, being alone, and the dark. Most of us have our own quirky fears, but when the fear begins to interfere with living our lives, it is time to do something about it. When people with a phobia are confronted with their feared situation, their anxiety can be quite intense, to the point of panic.

Phobias are best treated with behavioral and cognitive therapy techniques. Anxiety management training helps the person better tolerate anxiety when trying to approach the feared situation, and intentional practice doing the feared activity will almost assuredly decrease the anxiety. For some phobias it is hard to do “in vivo”, or real life, exposure, such as riding on an airplane. In these cases people can learn how to do exposure in imagery first, as a stepping-stone to real life exposure.

Social Anxiety: Also called social phobia, is a fear of social situations. Sometimes it is limited to very specific social situations, such as public speaking, test taking, dating, eating in restaurants, using public restrooms. Sometimes it is very generalized to virtually any public situation, such as being in a crowd, being around strangers, even answering the telephone. The basic fear underlying social anxieties is a fear of how others are going to judge or evaluate us.

Regardless of whether the social anxiety is specific or generalized, cognitive therapy is extremely important in learning to see the world differently. Anxiety reduction tools can help decrease anxiety to more manageable levels, allowing the socially anxious to gradually expose themselves to more and more anxiety provoking situations. With practice, the person desensitizes to the anxiety, and can live a freer life.

Generalized Anxiety Disorder: Also know as GAD, it is extreme worry, almost all day, everyday, about different things from minute to minute. People with GAD are often referred to as “worry-warts”. The constant worry usually results in extreme muscle tension, often resulting in painfully tight muscles in the shoulders and back, as well as tension headaches.

GAD responds very well to a combination of cognitive and behavioral treatments. Cognitive therapy techniques teach the person to better evaluate the real versus the imagined risks in life, and behavioral approaches teach the person to delay and eventually the excessive worry, and to alleviate the muscle tension that further feeds GAD.

Separation Anxiety: This form of anxiety is usually limited to children or early adolescents. Some separation anxiety is the norm for most of us at some point in our lives. But in some cases it becomes extreme, leading to difficulties going to school, or being away from a parent or a caregiver for even a moment.

As with many childhood anxiety problems, it is often best addressed by developing a behavior modification program administered by the adult. In such a case children can be rewarded for specific behaviors, such as going to school on the bus, or staying in their own bed at night. These rewards are often done with stars on a star chart (a calendar where the child gets to affix a colorful star each night he/she stays in bed all night). These stars are then used for rewards, usually doing something special with Mom or Dad. Also, even very young children can learn to overcome their irrational fears by learning that: “The more afraid you act, the more afraid you get. And the less afraid you act, the less afraid you get.”

Acute Stress Reaction: Imagine witnessing a horrendous accident. All of us would become anxious to some degree. Some of us would find this anxiety lingering and beginning to invade our lives. This would be an acute stress reaction.

Anxiety management training, learning to use cognitive and behavioral tools to decrease anxiety, is an excellent way to quickly put the intense anxiety reaction behind you. Prompt treatment of an acute anxiety reaction may lessen the possibility of later developing PTSD.

Post Traumatic Stress Disorder: Commonly referred to as PTSD, it is the long-term anxiety reaction to having experienced traumatic, anxiety provoking situations. It is most commonly thought of as being a result of combat experiences, but can result from other traumas such as accidents and crimes. It can result in the same intense panic-level anxiety as the other anxiety problems, and can also result in flashbacks, where the person finds himself or herself reliving the traumatic event, or recurring nightmares about the traumatic event.

Both cognitive and behavioral therapies are helpful with PTSD. Anxiety reduction tools can help one stem the rise of anxiety from ever getting to panic proportions. Exposure to triggers that activate the traumatic memories can result in desensitization to the anxiety, so that being in those situations no longer results in high anxiety.


Copyright © 2006 Dr. Joseph Brown, Ph.D.
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