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COURSES ARTICLE - THERAPYTOOLS.US Anxiety Disorders Course meets the qualifications for 7 hours of continuing education credit for MFTs and/or LCSWs as required by the California Board of Behavioral Sciences― Course Objectives: Upon completion of this course, the LCSW or MFT or Healthcare professional will be able to: 1. Identify the physical signs of Anxiety Disorders 2. Describe the psychological effects 3. Identify the causes of Anxiety Disorders 4. Learn the Diagnostic Process of Anxiety Disorders 5. Describe the available treatment modalities for Anxiety Disorders 6. Identify and describe medications and their uses in treating Anxiety Disorders 7. Understand Risk Factors to Assess Prior to Treatment 8. Understand Symptoms and How Symptoms are Reinforced Anxiety Disorders Introduction Panic Disorder Obsessive-Compulsive Disorder Post-Traumatic Stress Disorder Social Phobia (Social Anxiety Disorder) Specific Phobias Generalized Anxiety Disorder What Causes Anxiety Disorders Diagnosis of Anxiety Disorders Anxiety Disorders in Children Treatment of Anxiety Disorders Medications use in Anxiety Disorders Psychotherapies for Anxiety Disorders Risk Factors to Assess Prior to Treatment Facts About Anxiety Disorders Symptoms and How Symptoms are Reinforced References Introduction Anxiety disorders are the most common of all the mental health disorders. Considered in the category of anxiety disorders are: Generalized Anxiety Disorder, Panic Disorder, Agoraphobia, Social Phobia, Obsessive Compulsive Disorder, Specific Phobia, Post-Traumatic Stress Disorder, and Acute Stress Disorder. Anxiety disorders as a whole cost the United States between 42- 46 billion dollars a year in direct and indirect healthcare costs, which is a third of the yearly total mental health bill of 148 billion dollars. In the United States, social phobia is the most common anxiety disorder with approximately 5.3 million people per year suffering from it. Approximately 5.2 million people per year suffer from post-traumatic stress disorder. Estimates for panic disorder range between 3 to 6 million people per year, an anxiety disorder that twice as many women suffer from as men. Specific phobias affect more than 1 out of every 10 people with the prevalence for women being slightly higher than for men. Obsessive Compulsive disorder affects about every 2 to 3 people out of 100, with women and men being affected equally. Many people still carry the misperception that anxiety disorders are a character flaw, a problem that happens because you are weak. They say, "Pull yourself up by your own bootstraps!" and "You just have a case of the nerves." Wishing the symptoms away does not work -- but there are treatments that can help. Anxiety disorders and panic attacks are not signs of a character flaw. Most importantly, feeling anxious is not a person's fault. It is a serious mood disorder, which affects a person's ability to function in every day activities. It affects one's work, one's family, and one's social life. Today, much more is known about the causes and treatment of this mental health problem. We know that there are biological and psychological components to every anxiety disorder and that the best form of treatment is a combination of cognitive-behavioral psychotherapy interventions. Depending upon the severity of the anxiety, medication is used in combination with psychotherapy. Contrary to the popular misconceptions about anxiety disorders today, it is not a purely biochemical or medical disorder. There are as many potential causes of anxiety disorders as there are people who suffer from them. Family history and genetics play a part in the greater likelihood of someone getting an anxiety disorder in their lifetime. Increased stress and inadequate coping mechanisms to deal with that stress may also contribute to anxiety. Anxiety symptoms can result from such a variety of factors including having had a traumatic experience, having to face major decisions in a one's life, or having developed a more fearful perspective on life. Anxiety caused by medications or substance or alcohol abuse is not typically recognized as an anxiety disorder. Effective treatments for anxiety disorders are available, and research is yielding new, improved therapies that can help most people with anxiety disorders lead productive, fulfilling lives. Panic Disorder Case Examples: "It started 10 years ago, when I had just graduated from college and started a new job. I was sitting in a business seminar in a hotel and this thing came out of the blue. I felt like I was dying." "For me, a panic attack is almost a violent experience. I feel disconnected from reality. I feel like I'm losing control in a very extreme way. My heart pounds really hard, I feel like I can't get my breath, and there's an overwhelming feeling that things are crashing in on me." "In between attacks there is this dread and anxiety that it's going to happen again. I'm afraid to go back to places where I've had an attack. Unless I get help, there soon won't be anyplace where I can go and feel safe from panic." People with panic disorder have feelings of terror that strike suddenly and repeatedly with no warning. They can't predict when an attack will occur, and many develop intense anxiety between episodes, worrying when and where the next one will strike. If someone is having a panic attack, most likely his or her heart will pound and you he or she may feel sweaty, weak, faint, or dizzy. Hands may tingle or feel numb, and the person might feel flushed or chilled. The person may have nausea, chest pain or smothering sensations, a sense of unreality, or fear of impending doom or loss of control. The person may genuinely believe he or she having a heart attack or losing his or her mind, or on the verge of death. Panic attacks can occur at any time, even during sleep. An attack generally peaks within 10 minutes, but some symptoms may last much longer. Panic disorder affects about 2.4 million adult Americans1 and is twice as common in women as in men. It most often begins during late adolescence or early adulthood. Risk of developing panic disorder appears to be inherited. Not everyone who experiences panic attacks will develop panic disorder—for example, many people have one attack but never have another. For those who do have panic disorder, though, it's important to seek treatment. Untreated, the disorder can become very disabling. Many people with panic disorder visit the hospital emergency room repeatedly or see a number of doctors before they obtain a correct diagnosis. Some people with panic disorder may go for years without learning that they have a real, treatable illness. Panic disorder is often accompanied by other serious conditions such as depression, drug abuse, or alcoholism and may lead to a pattern of avoidance of places or situations where panic attacks have occurred. For example, if a panic attack strikes while a person is riding in an elevator, the person may develop a fear of elevators. If he or she starts avoiding them, that could affect his or her choice of a job or apartment and greatly restrict other parts of his or her life. Some people's lives become so restricted that they avoid normal, everyday activities such as grocery shopping or driving. In some cases they become housebound. Or, they may be able to confront a feared situation only if accompanied by a spouse or other trusted person. Basically, these people avoid any situation in which they would feel helpless if a panic attack were to occur. When people's lives become so restricted, as happens in about one-third of people with panic disorder,2 the condition is called agoraphobia. Early treatment of panic disorder can often prevent agoraphobia. Panic disorder is one of the most treatable of the anxiety disorders, responding in most cases to medications or carefully targeted psychotherapy. You may genuinely believe you're having a heart attack, losing your mind, or are on the verge of death. Attacks can occur at any time, even during sleep. Obsessive-Compulsive Disorder Case Examples: "I couldn't do anything without rituals. They invaded every aspect of my life. Counting really bogged me down. I would wash my hair three times as opposed to once because three was a good luck number and one wasn't. It took me longer to read because I'd count the lines in a paragraph. When I set my alarm at night, I had to set it to a number that wouldn't add up to a "bad" number." "Getting dressed in the morning was tough because I had a routine, and if I didn't follow the routine, I'd get anxious and would have to get dressed again. I always worried that if I didn't do something, my parents were going to die. I'd have these terrible thoughts of harming my parents. That was completely irrational, but the thoughts triggered more anxiety and more senseless behavior. Because of the time I spent on rituals, I was unable to do a lot of things that were important to me. "I knew the rituals didn't make sense, and I was deeply ashamed of them, but I couldn't seem to overcome them until I had therapy." Obsessive-compulsive disorder, or OCD, involves anxious thoughts or rituals a person feels he or she can't control. If a person has OCD, he or she may be plagued by persistent, unwelcome thoughts or images, or by the urgent need to engage in certain rituals. He or she may be obsessed with germs or dirt, and wash his or her hands over and over. She or he may be filled with doubt and feel the need to check things repeatedly, or may have frequent thoughts of violence, and fear that she or he will harm people close to she or he.