Anxiety disorders are common, but treatable

Strolling across Turin's Piazza Vittorio Veneto can be breathtaking with people pausing to take pictures or sitting down to eat a snack. For Sara Arndt, walking across the plaza triggered a panic attack during her family's vacation after she became convinced that a sniper was aiming at her from nearby rooftops.

For those who suffer from anxiety disorders, simple tasks such as walking across a plaza or driving over a bridge can be debilitating.

Arndt, 24, a high school English teacher in Greer, S.C., was diagnosed when she was 15 with anxiety after experiencing severe insomnia, hyperventilating and exhibiting signs of excessive cleaning.

"I had racing thoughts and I would get really paranoid which would give me heart palpitations," she said.

Individual therapy sessions she received while in college helped her refocus on what was likely to happen and what was not, said Arndt.

"The therapist gave me a great tool. She told me to think about probability versus possibility," she said. "Whenever I get anxious, I stop and think that just because something is possible, it is mostly in my head."

Arndt has also used medication, although she is reluctant to use the her prescription for lorazapam unless feels a panic attack coming. Lorazapam, part of the benzodiazepine drug family, is prescribed for anxiety, insomnia and acute seizures.

"When an attack happens, my brain is like a runaway train. I know this is running out of control, but I try not to take medicine if I can help it because it completely flat lines my emotions," she said. "I feel like a zombie."

The Anxiety Disorders Association of America, based in Maryland, said anxiety disorders are the most common mental illness in the United States, affecting 18 percent of the adult population.

"I've had patients who can't leave their house because of their fears," said Mark Pfeffer, a Chicago psychologist.

As the director of the Panic/Anxiety Recovery Center in Chicago, Pfeffer gets calls from people who don't have resources available to help cope with anxiety.

Pfeffer, who has been on the A&E show "Hoarders," organized an eight-week alternative therapy plan with Second City comedy club for improv classes lasting two hours with a one-hour group therapy session earlier this year for people who suffer from social anxiety.

"There is a magic that can happen in group therapy," he said. "People learn from each other and recognize that they aren't the only ones feeling this way. I learn from their interactions as well."

Other psychologists are also addressing anxiety through alternative group therapies. Chris Carr, a sports and performance psychologist with St. Vincent Hospital in Indianapolis, created a unique program which addresses performance anxiety for those in high-performing occupations including athletes, police officers and firefighters.

"Performance psychology is dealing with a population of people who perform at a critical time and have to do their best," he said. "There is little room for error or mistakes."

After counseling injured athletes, Carr noticed the effort put into rehabilitating the bodies of the athletes but nothing focused on the emotional and cognitive part of recovery. From there, he expanded into the performance fields.

"In some fields such as firefighters and the military, if they don't perform well at a critical time, it could cause a further loss of property or even lives," he said. "That's a lot of pressure."

Carr said people who suffer with job performance anxiety may not be aware they have performance anxiety until a stressful event occurs.

Pfeffer said society has stereotyped people with anxiety disorders. "People with anxiety are deemed weak or non-functioning, when the reality is that they are some of the most high-functioning individuals," he said.

"When 9/11 happened, I was worried that my patients would be suffering more but they were the calmest. They told me that now everyone had a glimpse of the fear that they live through each day," he said.

Similarly, Carr, who has treated children as young as 10 with performance anxiety, agreed that people can be too critical for those with anxiety disorders.

"Most people who are critical have no idea what it's like to live in a fishbowl where every move is criticized," he said. "They have zero expertise in the area they're criticizing, but they do it anyway."

People from all walks of life can be susceptible to anxiety, said Amy West, a clinical psychologist at the University of Illinois at Chicago. West, who researches pediatric mood disorders, developed severe anxiety as a child, leading her to study mood disorders as a psychologist.

She began researching "temperament," or biological predispositions that will develop in children such as depression or hyperactivity that can lead to mood disorders such as anxiety and depression as adults after arriving at UIC in September 2005.

"My field of choice is somewhat related to what I went through as a child," West said.

With a "sensitive but outgoing" temperament, she now recognizes warning signs of her anxiety disorder in her childhood, first manifesting at age 9 when she became obsessed with nuclear war.

"This was in the 1980s and I was terrified. My mom would find me crying at night and sleeping with all the lights on," she said.

As a teenager, West developed another phobia--flying. Although she had been on planes since age 5, suddenly she was experiencing panic attacks for days before family trips.

"My dad and I developed a routine," she said. "On the plane, I would put my head in his lap and hold his hand while he talked me through each sound we heard as the plane was taking off."

The routine, along with cognitive behavioral therapy sessions, helped West reverse her anxiety for flying, although she periodically suffered from panic attacks since high school.

"Anxiety isn't like other mood disorders like depression or schizophrenia. It's not a chemical imbalance but a dysfunctional way of thinking," West said. "Through therapy and medication, you can teach your mind on what to focus on and what not to focus on."

Carr agreed, stating that performers have to work on a routine before a big game or they go out on duty to balance a normal level of adrenaline from panic-inducing attacks.

"As the saying goes, we don't want to get rid of butterflies in the stomach, we just want them to fly in a formation," he said. "It's a delicate balance to find optimal focus in an optimal mental state and a lot of performers don't spend time on their pre-performance routine."

For some, though, routines are not enough and a combination of medication and therapy is the best treatment, Carr said.

Similarly, West said treatments should be made on an individual basis with some responding better to group exercises while others need one-on-one sessions with a therapist. Medicines are useful for the short-term to prevent the physiological effects of having panic attacks but have some have serious side effects.

Drugs containing benzodiazepine such as Xanax, which is the most proscribed sedative in 2010, act fast when a sudden panic attack happens but are highly addictive, she said.

SSRIs, or selective serotonin reuptake inhibitors, are antidepressants and do not have addictive long-term effects, West said. Zoloft and Prozac are both commonly prescribed SSRIs.

Arndt realized that a combination of medication and therapy have allowed her to develop a routine so she can function on a normal level.

"There are still times when i go down the line of obsessive thoughts and have to think about something I enjoy instead," she said. "But, I feel that I have control again."