ADAA is pleased to provide a forum for FAQs that we receive from our public community. We forward all questions to one of our ADAA professional members and they respond here. We share these questions and answers on this website page, through our social media platforms and in our monthly "Ask an ADAA Therapist" e-newsletter column in our monthly issue of Triumph. Have a question? Please email email@example.com.
- Question: Anxiety Attacks - What Can Help?
- Question: PTSD and Ativan
- Question: Is participating in an online support group really helpful if you have an anxiety disorder or depression?
- Question: Can I 'get over' my anxiety without seeking help?
- Question: How do I know if I should be on medication for anxiety or depression?
- Question: How can I support my family member with anxiety without fueling it?
! was diagnosed with general anxiety disorder about a year ago. I sought treatment and after a couple sessions was doing much better. My anxiety only comes on when I feel time pressure such as wanting to leave to get to a place on time for rational and irrational events...such as being 15 minutes away from a location and being on schedule to get there early but all of a sudden I get an anxiety attack. It feels like an elephant is on my chest and my mood changes and makes me distant. Is there a medication I can talk to my doctor about that would help relieve these sudden on set symptoms? I was prescribed beta blockers before and they did absolutely nothing for me.
Answer: David Rosmarin, PhD, ABPP
The best medication for anxiety is Exposure Therapy. What will happen to you if you’re late and have an anxiety attack? Probably not much. Anxiety is scary, but not dangerous. So, practice facing your fears. If you’re afraid of being late, set your watch five minutes slow for two weeks. If you’re afraid of the physical feelings of anxiety, let yourself panic. And if you’re afraid of something else, like being embarrassed if others see you panic, practice feeling hot and uncomfortable (or at least pretending to) in the presence of others. Sometimes it’s possible to do these on your own, and other times it’s helpful to get support from a therapist who has experience with exposure therapy.
Center for Anxiety. Dr. Rosmarin’s clinical work and research have received media attention from ABC, NPR, Scientific American, the Wall Street Journal, and the New York Times.
Question: PTSD and Ativan
I have PTSD due to a traumatic event that occurred in my life 3 years ago. I am 60 and never had anxiety or depression before this. I am working with a trauma specialist and am on an anti depressant, which quite frankly is not helping me. The only thing that seems to help is Ativan. Is it true that this medication cannot be used long-term? It truly is the only medication that calms me enough so that I can function and participate in life.
Answer: Karen Martinez, MD
There are some concerns with the long-term use of Ativan (lorazepam) and other benzodiazepines such as Klonopin (clonazepam) and Xanax (alprazolam) because of the potential of addiction to these medications as well as reports of association with changes in cognitive function if used for long periods of time. I do have some patients with a variety of anxiety disorders, including PTSD, that need to use these medications in the long-term and what I do is try to keep it in the lower dose possible and continuously monitor for any sign of addiction or cognitive changes. Addiction means both physical and psychological dependence to a medication in addition to having tolerance (need to increase the dose continuously to have the same effect) and not responding to the medication at the prescribed dose. If a patient with PTSD is on a medication at the same dose for a long period of time it is not considered addiction.
It certainly can be! But it is not a substitute for professional help.
Many people find that online support groups can be very helpful for emotional difficulties like anxiety or depression. It can be extremely comforting knowing that there are others out there who share the same problem! Another way in which online support groups can be useful is that you can learn helpful strategies there for coping with anxiety or depression. If they've worked for others, maybe they will work for you too.
However, it's important to know that anxiety disorders and depression are conditions that typically respond well to treatment. Do not mistake participating in an online group for receiving actual treatment (helpful as the groups can be). One great thing that I've seen people get from online groups is inspiration from stories of those who have overcome the same problem by seeking therapy or medication.
Unfortunately, there can be a downside to such groups. For people with obsessive compulsive symptoms, participating in the group can itself become a ritual that worsens symptoms. Also sometimes people in these groups recommend approaches or strategies that are not helpful, or strategies that have worked well for them but would be counterproductive for you. In my opinion, these disadvantages of online support groups are real limitations on how useful they are.
In summary, online support groups can certainly be helpful, but have some downsides and are no substitute for getting professional treatment.
Dr. Paul Greene is the director of the Manhattan Center for Cognitive-Behavioral Therapy in New York City. He received his doctorate in clinical psychology from Boston University and completed postdoctoral training at Memorial Sloan-Kettering Cancer Center and the Mount Sinai School of Medicine. Dr. Greene served as an assistant professor at the Mount Sinai School of Medicine for six years. He is an expert in the treatment of anxiety and related disorders, and the application of mindfulness in cognitive-behavioral clinical interventions.
When it comes to medication, people usually feel one of two ways about it. There are those who are “anti-medication” and would rather do just about anything to get better without the need for a prescription and then there are those who want medication because they see it as the “magic pill” that will take care of all their problems. Before jumping to medication, I would suggest seeking a medical professional to answer any questions you may have about the process. Ideally, consulting with a mental health therapist to identify what symptoms you are presenting with can help make sense of the process ahead. The mental health professional will explore the wide range of anxiety disorders or depression severities so that you are able to better understand your symptoms and how to overcome them. ADAA also has a lot of resources that you can go through to learn more facts about anxiety and depression. Cognitive Behavioral Therapy (CBT) has been an effective component in treating anxiety disorders. Behavioral activation along with CBT can be helpful in the treatment of depression.
So, when is the right time to consider medication? I would say when you find that the anxiety or depression has become debilitating and starts to affect your ability to function. Do you find that anxiety or depression is causing strain in your relationships, or is it hard to maintain your focus at work because you are too in your head? These symptoms can affect your overall well-being, so you want to take action. Your therapist can help you find a psychiatrist, or you can contact your primary care provider to discuss medication options. Research has shown that a combination of both CBT and medication has been the most effective treatment intervention. With that being said, do note that medication is just one of the many available tools in the “anxiety toolbox.” Once you learn the skills to cope, start practicing what you have learned and implement these techniques into your daily routine you will begin to see positive changes.
Want to take the first step? Check out ADAA’s Find A Therapist tool to find a therapist near you.
Dominique received her Masters from DePaul University in Clinical Mental Health Counseling. Her clinical experiences include working at a non-profit helping kids, teens, adolescents and adults experiencing trauma. Prior to working at NVisionYou, Dominique worked in private practice specializing in the treatment of anxiety, depression, OCD, specific phobias, trichotillomania and other stress-related disorders. Dominique is a Licensed Professional Counselor and is board certified. Dominique is also on the public education committee for the Anxiety and Depression Association of America where she aims to improve and expand public education and outreach about anxiety, depression and co-occurring disorders through website content, webinars, blog posts, social media outreach and other collaborative educational projects.
Question: Can I ‘get over’ my anxiety without seeking help?
Answer: by ADAA member Richa Bhatia, MD, FAPA
Experiencing some feelings of nervousness or worry is a normal reaction to stressors, and may even be useful in certain situations. However, if anxiety becomes excessive, pervasive, or difficult to control, and is affecting one or more areas of your life, you may be suffering from an anxiety disorder. In this case, it is important to seek help. You should also seek help, if you are unsure if your anxiety is a normal part of life or an anxiety disorder.
If you suffer from an anxiety disorder, the risks of not seeking professional help are significant. Untreated, anxiety disorders can become worse and more debilitating over time, often leading to avoidance and significant impairment in key aspects of life such as work, school, relationships and/or social functioning.
The good news is that effective, well-researched and safe treatments for anxiety disorders are available. Your doctor will first do a check-up to ensure that the anxiety is not resulting from an underlying medical problem. For the treatment of anxiety disorders, psychotherapy or medications or both, may be recommended. This recommendation is typically made in collaboration with you, taking into account the type and severity of your condition along with other factors.
Often, people are reluctant to seek help because they are concerned about cost or potential inconveniences related to treatment, or about side effects they may have heard about. If you have concerns or doubts, do discuss and clarify these with your primary care physician who can guide you in the right direction. Once you seek professional help for anxiety and have concerns or questions about a treatment option, you should not hesitate to discuss these with your treating provider. They can answer your questions, and in many cases, offer solutions that alleviate your concerns, thereby, arriving at a treatment plan that you are comfortable with.
Richa Bhatia, MD, FAPA is a Child, Adolescent and Adult psychiatrist, dual Board certified in Child, Adolescent and General Psychiatry. She is the author of 2 books: ‘Demystifying Psychiatric Conditions and Treatments’ and ‘65 Answers about Psychiatric Conditions’. Previously, she served as a faculty member in the departments of psychiatry at Harvard Medical School and Geisel School of Medicine at Dartmouth. She serves as an Associate Editor for Current Psychiatry, Section Editor for Current Opinion in Psychiatry and is on the editorial board of several other psychiatry journals. She is an expert contributor for Psychology Today and Thrive Global. Some of her interests are childhood depressive and anxiety disorders, the interface between medical and psychiatric conditions, differential diagnosis, compassion and bullying prevention. She is an active member of the Child and Adolescent Psychiatry Section of the World Psychiatric Association (WPA), the American Psychiatric Association and the Anxiety and Depression Association of America.
Supporting a family member with anxiety can feel very overwhelming and confusing, as we often don’t know when to push, when to lean back, and how to be the most helpful. Many loved ones have commented they want to do whatever they possibly can for their family member with anxiety, but also feel like they are walking on eggshells and have no idea what to do.
Family accommodation is very common. Relatives are drawn into the anxiety cycle by helping perform rituals, supporting avoidance, and/or giving excessive reassurance. While our intentions are good, we make promises we can’t actually keep (“nothing bad will ever happen”), take on power we don’t have (“don’t worry, I will protect you”), and/or try to push away the problem all together (“you are fine”). While these strategies may seem supportive, they are really only a short-term fix and do not support the individual with anxiety in getting unstuck.
So what can we do? First, our loved ones with anxiety want to be heard and understood. We need to validate their experience and hear their struggle. If your spouse is really worried about losing their job or your child believes touching a doorknob an odd number of times will make him bad, we can help acknowledge how difficult this is for them (“I know this is really scary for you” or “It’s okay to feel uncertain”).
Second, we have to set reasonable boundaries around our own behaviors and support them in setting their own boundaries. By reducing accommodation in the present, they will have the opportunity to build their own skills for the future. A new program called SPACE (Supportive Parenting for Anxious Childhood Emotions) has found that behavior change in parents can have a significant impact on their child’s anxiety.
Lastly, we want to offer support in the form of encouragement. We can praise our loved ones bravery, flexibility, tolerance, acceptance, strength, and willingness to make changes. We can cheer them on when they approach hard things, exuding our confidence in their abilities and resilience (“you are strong and you can do this”).
Andrea Umbach, Psy.D., ABPP, is a licensed psychologist and founding partner at BASE Cognitive Behavioral (www.findyourbase.com) in Charlotte, NC. She is board certified in Behavioral & Cognitive Psychology. Dr. Umbach enjoys working with adults, teens, and kids 12+ in both individual and group formats as well as provides trainings, presentations, and consultations. She is the author of "Conquer Your Fears & Phobias for Teens,” a unique resource for teens (and adults) to better understand the cycle of anxiety and how to overcome it. She has been an ADAA member for over 10 years and serves on the public education committee. Dr. Umbach was honored with the ADAA Clinician Trainee Award (2012) and participated in Alies Muskin Career Development Leadership Program (2016). She also founded the Charlotte Anxiety Consortium (www.charlotte-anxiety.org).
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