Culturally Competent Psychotherapy for African-American Individuals, Couples, and Families
Are You Experiencing Stress Or Anxiety?
It’s important to know how to identify and differentiate signs of stress and anxiety. Stress is a common trigger for anxiety and it’s important to catch anxiety symptoms early to prevent development of an anxiety disorder.
Most people experience stress and anxiety at some point in their lives. Depending on the level of severity, they can detrimentally impact one’s quality of life. Although stress and anxiety share many of the same emotional and physical symptoms – uneasiness, tension, headaches, high blood pressure and loss of sleep – they have very different origins. Determining which one you’re experiencing is critical to finding an effective treatment plan and feeling better.
Generally, stress is a response to an external cause, such as a tight deadline at work or having an argument with a friend, and subsides once the situation has been resolved. Because stress is caused by external factors, tackling these head-on can help. If you’re experiencing prolonged, chronic stress, there are many ways to manage and reduce your symptoms, including physical activity, breathing exercises, adequate sleep and taking time connect with others.
Anxiety is a person’s specific reaction to stress; its origin is internal. Anxiety is typically characterized by a “persistent feeling of apprehension or dread” in situations that are not actually threatening. Unlike stress, anxiety persists even after a concern has passed. In more severe cases, anxiety can escalate into an anxiety disorder, the most common mental health issue in the U.S. Anxiety disorders are classified in a variety of ways: generalized anxiety, panic disorder, phobias, social anxiety, obsessive-compulsive disorder and post-traumatic stress disorder (PTSD).
Generalized anxiety disorder (GAD) is a pattern of frequent, constant worry and anxiety over many different activities and events. It is estimated by the American Institute of Stress, that 75% to 90% of all doctor’s visits are caused by reactions to stress.
Stress poses a profound difficulty for everyone, but is a particular problem for Blacks:
- 50% of African Americans who suffer from the “blues” or depression do not seek help.
- 88% of women and 69% of men will get headaches and stress is the number one cause.
- Stress is the number one health problem facing African Americans. 35% of African American men compared to 25% of other ethnic groups are affected by hypertension (high blood pressure).
- 1 out of every 9 women who seek care in the emergency rooms is there because of injuries resulting from domestic violence. There is evidence to support that neighborhood crime is rooted in unhealthy stress.
- More black men die from heart attacks associated with stress than any other ethnic group in the United States.
Causes of GAD: The exact cause of GAD is not fully known, but a number of factors — including genetics, brain chemistry and environmental stresses — appear to contribute to its development.
- Genetics: Some research suggests that family history plays a part in increasing the likelihood that a person will develop GAD. This means that the tendency to develop GAD may be passed on in families
- Brain chemistry: GAD has been associated with abnormal levels of certain neurotransmitters in the brain. Neurotransmitters are special chemical messengers that help move information from nerve cell to nerve cell. If the neurotransmitters are out of balance, messages cannot get through the brain properly. This can alter the way the brain reacts in certain situations, leading to anxiety
- Environmental factors: Trauma and stressful events, such as abuse, the death of a loved one, divorce, changing jobs or schools, may lead to GAD. GAD also may become worse during periods of stress. The use of and withdrawal from addictive substances, including alcohol, caffeine, and nicotine, can also worsen anxiety.
Symptoms--A person with GAD may:
- Worry very much about everyday things
- Have trouble controlling constant worries
- Know that they worry much more than they should
- Not be able to relax
- Have a hard time concentrating
- Be easily startled
- Have trouble falling asleep or staying asleep
- Feel tired all the time
- Have headaches, muscle aches, stomach aches, or unexplained pains
- Have a hard time swallowing
- Tremble or twitch
- Be irritable, sweat a lot, and feel light-headed or out of breath
- Have to go to the bathroom a lot.
Exams and Tests: If symptoms of GAD are present, your doctor will begin an evaluation by asking questions about your medical history and performing a physical examination. Although there are no laboratory tests to specifically diagnose anxiety disorders, the doctor may use various tests to look for physical illness as the cause of the symptoms. The doctor bases his or her diagnosis of GAD on reports of the intensity and duration of symptoms — including any problems with functioning caused by the symptoms. The doctor then determines if the symptoms and degree of dysfunction indicate a specific anxiety disorder. GAD is diagnosed if symptoms are present for more days than not during a period of at least six months. The symptoms also must interfere with daily living, such as causing you to miss work or school.
Treatments: First, talk to your doctor about your symptoms. Your doctor should do an exam to make sure that another physical problem isn’t causing the symptoms. The doctor may refer you to a mental health specialist. GAD is generally treated with psychotherapy, medication, or both.
- Psychotherapy. A type of psychotherapy called cognitive behavior therapy is especially useful for treating GAD. It teaches a person different ways of thinking, behaving, and reacting to situations that help him or her feel less anxious and worried.
- Medication. Doctors also may prescribe medication to help treat GAD. Two types of medications are commonly used to treat GAD—anti-anxiety medications and antidepressants. Anti-anxiety medications are powerful and there are different types. Many types begin working right away, but they generally should not be taken for long periods.
- Antidepressants are used to treat depression, but they also are helpful for GAD. They may take several weeks to start working. These medications may cause side effects such as headache, nausea, or difficulty sleeping. These side effects are usually not a problem for most people, especially if the dose starts off low and is increased slowly over time. Talk to your doctor about any side effects you may have.
It’s important to know that although antidepressants can be safe and effective for many people, they may be risky for some, especially children, teens, and young adults. A “black box”—the most serious type of warning that a prescription drug can have—has been added to the labels of antidepressant medications. These labels warn people that antidepressants may cause some people to have suicidal thoughts or make suicide attempts. Anyone taking antidepressants should be monitored closely, especially when they first start treatment with medications.
Some people do better with cognitive behavior therapy, while others do better with medication. Still others do best with a combination of the two. Talk with your doctor about the best treatment for you.
Possible Complications:Generalized anxiety disorder does more than just make you worry. It can also lead to, or worsen, other mental and physical health conditions, including:
- Substance abuse
- Trouble sleeping (insomnia)
- Digestive or bowel problems
- Teeth grinding (bruxism)
- Substance use disorders
When to Contact a Medical Professional: If you think you have an anxiety disorder, the first person you should see is your family doctor. A physician can determine whether the symptoms that alarm you are due to an anxiety disorder, another medical condition, or both.
Preventions: Anxiety disorders like GAD cannot be prevented. However, there are some things that you can do to control or lessen symptoms, including:
- Stop or reduce your consumption of products that contain caffeine, such as coffee, tea, cola and chocolate.
- Ask your doctor or pharmacist before taking any over-the-counter medicines or herbal remedies. Many contain chemicals that can increase anxiety symptoms.
- Exercise daily and eat a healthy, balanced diet.
- Seek counseling and support after a traumatic or disturbing experience.
- Practice stress management techniques like yoga or meditation.
Natural Remedies: Some anxiety is normal—but it shouldn’t interfere with your ability to function. According to research and other evidence, the following self-care steps may be helpful:
- Address your stress
- Reduce stress with meditation, counseling, and other methods
- Avoid caffeine
- If you are anxious, avoid stimulants such as caffeine
- Aim for better nutrition with a multivitamin--Taking one a day may help reduce anxiety and feelings of stress
OBSESSIVE-COMPULSIVE DISORDER (OCD)
What Is Obsessive-Compulsive Disorder? Obsessive-compulsive disorder (OCD) is an anxiety disorder in which time people have recurring, unwanted thoughts, ideas or sensations (obsessions) that make them feel driven to do something repetitively (compulsions). The repetitive behaviors, such as hand washing, checking on things or cleaning, can significantly interfere with a person’s daily activities and social interactions.
Many people have focused thoughts or repeated behaviors. But these do not disrupt daily life and may add structure or make tasks easier. For people with OCD, thoughts are persistent and unwanted routines and behaviors are rigid and not doing them causes great distress. Many people with OCD know or suspect their obsessions are not true; others may think they could be true (known as poor insight). Even if they know their obsessions are not true, people with OCD have a hard time keeping their focus off the obsessions or stopping the compulsive actions.
A diagnosis of OCD requires the presence of obsession and/or compulsions that are time-consuming (more than one hour a day), cause major distress, and impair work, social or other important function. About 1.2 percent of Americans have OCD and among adults slightly more women than man are affected. OCD often begins in childhood, adolescence or early adulthood; the average age symptoms appear is 19 years old.
Obsessions: are recurrent and persistent thoughts, impulses, or images that cause distressing emotions such as anxiety or disgust. Many people with OCD recognize that the thoughts, impulses, or images are a product of their mind and are excessive or unreasonable. Yet these intrusive thoughts cannot be settled by logic or reasoning. Most people with OCD try to ignore or suppress such obsessions or offset them with some other thought or action. Typical obsessions include excessive concerns about contamination or harm, the need for symmetry or exactness, or forbidden sexual or religious thoughts.
Compulsions: are repetitive behaviors or mental acts that a person feels driven to perform in response to an obsession. The behaviors are aimed at preventing or reducing distress or a feared situation. In the most severe cases, a constant repetition of rituals may fill the day, making a normal routine impossible. Compounding the anguish these rituals cause is the knowledge that the compulsions are irrational. Although the compulsion may bring some relief to the worry, the obsession returns and the cycle repeats over and over.
Some examples of compulsions:
- Cleaning to reduce the fear that germs, dirt, or chemicals will "contaminate" them some spend many hours washing themselves or cleaning their surroundings. Some people spend many hours washing themselves or cleaning their surroundings.
- Repeating to dispel anxiety. Some people utter a name or phrase or repeat a behavior several times. They know these repetitions won’t actually guard against injury but fear harm will occur if the repetitions aren’t done.
- Checking to reduce the fear of harming oneself or others by, for example, forgetting to lock the door or turn off the gas stove, some people develop checking rituals. Some people repeatedly retrace driving routes to be sure they haven’t hit anyone.
- Ordering and arranging to reduce discomfort. Some people like to put objects, such as books in a certain order, or arrange household items “just so,” or in a symmetric fashion.
- Mental compulsions to response to intrusive obsessive thoughts, some people silently pray or say phrases to reduce anxiety or prevent a dreaded future event.
Other conditions sharing some features of OCD occur more frequently in family members of OCD patients. These include, for example, body dysmorphic disorder (preoccupation with imagined ugliness), hypochondriasis (preoccupation with physical illness), trichotillomania (hair pulling), some eating disorders such as binge eating disorder, and neurologically based disorders such as Tourette’s syndrome.
The Most Effective Treatments for OCD: are a type of CBT called Exposure and Response Prevention (ERP), which has the strongest evidence supporting its use in the treatment of OCD, and/or a class of medications called serotonin reuptake inhibitors, or SRIs.
Exposure and Response Prevention is typically done by a licensed mental health professional (such as a psychologist, social worker, marriage and family therapist, or mental health counselor) in an outpatient setting. This means you visit your therapist’s office at a set appointment time once or a few times a week.
Medications such as fluvoxamine (Luvox®), fluoxetine (Prozac®), sertraline (Zoloft®), paroxetine (Paxil®), citalopram (Celexa®), clomipramine (Anafranil®), escitalopram (Lexapro®), venlafaxine (Effexor®), which are used to treat OCD can only be prescribed by a licensed medical professionals (such as your physician or a psychiatrist), who would ideally work together with your therapist to develop a treatment plan.
Taken together, ERP and medication are considered the “first-line” treatments for OCD. About 70% of people will benefit from ERP and/or medication for their OCD.
For more information about OCD, please visit International OCD Foundation.
A panic attack is a symptom of anxiety, not stress. During a panic attack, people will experience symptoms like those of a heart attack, including chest pain, sweating, feeling faint, nausea, chills and breathing difficulties. It develops abruptly and usually peaks within 10 minutes. (Of course, to be safe, never hesitate to call 911.)
A panic attack is the abrupt onset of intense fear or discomfort that reaches a peak within minutes and includes at least four of the following symptoms:
- Palpitations, pounding heart, or accelerated heart rate
- Trembling or shaking
- Sensations of shortness of breath or smothering
- Feelings of choking
- Chest pain or discomfort
- Nausea or abdominal distress
- Feeling dizzy, unsteady, light-headed, or faint
- Chills or heat sensations
- Paresthesia (numbness or tingling sensations)
- Derealization (feelings of unreality) or depersonalization (being detached from oneself) Listen to this podcast.
- Fear of losing control or “going crazy”
- Fear of dying
Some people experience what is referred to as limited-symptom panic attacks, which are similar to full-blown panic attacks but consist of fewer than four symptoms.
Although anxiety is often accompanied by physical symptoms, such as a racing heart or knots in your stomach, what differentiates a panic attack from other anxiety symptoms is the intensity and duration of the symptoms. Panic attacks typically reach their peak level of intensity in 10 minutes or less and then begin to subside. Due to the intensity of the symptoms and their tendency to mimic those of heart disease, thyroid problems, breathing disorders, and other illnesses, people with panic disorder often make many visits to emergency rooms or doctors' offices, convinced they have a life-threatening issue.
Panic attacks can occur unexpectedly during a calm state or in an anxious state. Although panic attacks are a defining characteristic of panic disorder, it is not uncommon for individuals to experience panic attacks in the context of other psychological disorders. For example, someone with social anxiety disorder might have a panic attack before giving a talk at a conference and someone with obsessive-compulsive disorder might have a panic attack when prevented from engaging in a ritual or compulsion.
Panic attacks are extremely unpleasant and can be very frightening. As a result, people who experience repeated panic attacks often become very worried about having another attack and may make changes to their lifestyle so as to avoid having panic attacks. For example, avoiding exercise so as to keep their heart rate low, or avoiding certain places.
In the past it might have taken months or years and lots of frustration before getting a proper diagnosis. Some people are afraid or embarrassed to tell anyone, including their doctors or loved ones about what they are experiencing for fear of being seen as a hypochondriac. Instead they suffer in silence, distancing themselves from friends, family, and others who could be helpful. Other people suffering from panic attacks don't know they have a real and highly treatable disorder. It is our hope that through increased education, people will feel more empowered to discuss their symptoms with a healthcare professional and seek appropriate treatment.
High bridges, new places, or old elevators may make us a bit uneasy or even frightened. We might try to avoid things that make us uncomfortable, but most people generally manage to control their fears and carry out daily activities without incident.
But people with specific phobias, or strong irrational fear reactions, work hard to avoid common places, situations, or objects even though they know there's no threat or danger. The fear may not make any sense, but they feel powerless to stop it.
People who experience these seemingly excessive and unreasonable fears in the presence of or in anticipation of a specific object, place, or situation have a specific phobia.
Having phobias can disrupt daily routines, limit work efficiency, reduce self-esteem, and place a strain on relationships because people will do whatever they can to avoid the uncomfortable and often-terrifying feelings of phobic anxiety.
While some phobias develop in childhood, most seem to arise unexpectedly, usually during adolescence or early adulthood. Their onset is usually sudden, and they may occur in situations that previously did not cause any discomfort or anxiety.
Specific phobias commonly focus on animals, insects, germs, heights, thunder, driving, public transportation, flying, dental or medical procedures, and elevators. Although people with phobias realize that their fear is irrational, even thinking about it can often cause extreme anxiety.
The defining feature of social anxiety disorder, also called social phobia, is intense anxiety or fear of being judged, negatively evaluated, or rejected in a social or performance situation. People with social anxiety disorder may worry about acting or appearing visibly anxious (e.g., blushing, stumbling over words), or being viewed as stupid, awkward, or boring. As a result, they often avoid social or performance situations, and when a situation cannot be avoided, they experience significant anxiety and distress. Many people with social anxiety disorder also experience strong physical symptoms, such as a rapid heart rate, nausea, and sweating, and may experience full-blown attacks when confronting a feared situation. Although they recognize that their fear is excessive and unreasonable, people with social anxiety disorder often feel powerless against their anxiety.
Social anxiety disorder affects approximately 15 million American adults and is the second most commonly diagnosed anxiety disorder following specific phobia. The average age of onset for social anxiety disorder is during the teenage years. Although individuals diagnosed with social anxiety disorder commonly report extreme shyness in childhood, it is important to note that this disorder is not simply shyness.
Social anxiety disorder can wreak havoc on the lives of those who suffer from it. For example, individuals may decline a job opportunity that requires frequent interaction with new people or avoid going out to eat with friends due to a fear that their hands will shake when eating or drinking. Symptoms may be so extreme that they disrupt daily life and can interfere significantly with daily routines, occupational performance, or social life, making it difficult to complete school, interview and get a job, and have friendships and romantic relationships. People with social anxiety disorder are also at an increased risk for developing major depressive disorder and alcohol use disorders.
Despite the availability of effective treatments, fewer than 5% of people with social anxiety disorder seek treatment in the year following initial onset and more than a third of people report symptoms for 10 or more years before seeking help.