ACADEMY PUBLIC POLICIES

Isolation - A short documentary on Depression & Anxiety

Anxiety & Depression

Anxiety and Depression Association of America - Depression

Where can I find an anxiety disorders support group, and how could that help me?

Group therapy can provide one of the mainstays in treatment for anxiety disorders, and an anxiety disorder support group can provide an essential touchstone. The easiest place to start this process is the Anxiety Disorders of America Association (ADAA) Web site. You can enter your state and zip code and they will contact you with the closest meeting place. You can meet others who have suffered from anxiety, educate yourself more about anxiety disorders, find a referral for treatment, and learn of different group therapy options. The group modality of treatment can prove invaluable with anxiety disorders. The power of the group and the strength drawn from surrounding yourself with others who suffer from symptoms similar to your own yields a calming, stabilizing presence. This technique can combat the feelings of shame and secrecy that so often go along with anxiety.  Believe it or not, you are not alone out there.

Selma’s comments:

My anxiety disorders support group was comprised of me and my analyst, and it helped me to transform myself from inappropriate energy wasting and life-destroying anxieties. I came to accept life’s realistic anxieties, which can be handled. This allows me to live a life that can be constructive and creative and competent with consistent, applied, hard work. This support group involved both of us concentrating and sifting through a problem and allowing it to be disbursed in a different way. With slow, laborious, dedicated work, my life was changed forever. This support group of two saved my life, and indeed, gave me life. Whatever support group is used, I would think it cannot be an outside-of-you experience. You have to be the most active member of the support group; as it seems to me, the only person that makes the change develop is oneself.

There is no question in my mind that I could not have done it without my analyst. No one else or no other group could possibly have supplied that intense concentration on me, coupled with a depth of knowledge and training.

What do I do if all else fails?

If all else fails, two major strategies come to mind. If you have tried various treatments that simply have not worked for one reason or another, it may be that you suffer from an unconscious source of anxiety that, were it conscious and available to the surface of your mind, would be more known and amenable to intervention. In these situations, finding a well-trained psychoanalyst who comes with a highly regarded referral in your area can be invaluable. To find one near you, go the Web site of the American Psychoanalytic Association.

If Western medicine and its medical model has failed you, or you feel unable to settle into any of the more traditional Western treatment frames described in this texts, then I would recommend you go East. The Eastern medical model-often integrated with the best of what we know in the West-uses a different framework to diagnose and treat disease. Many patients who cannot become comfortable or find effective therapeutics with the Western model have gone East and had success. Why this phenomenon takes place is complicated and may stem from a genuine recognition of the inseparability of the mind and the body. But if all else has failed, you stand only to gain by consulting with the traditional Chinese medical doctor in your area. If your internist cannot help you find one, then you might try the closest Chinese embassy, cultural center, or language center as a point of departure.

Selma’s comments:

Everything failing is a thought that never occurred to me in all the years of my analysis. That is not to say my treatment always looked up, forward, or encouraging. There were dark days, weeks of them . . . especially in my adolescence. There were terrible mood swings and deep regressions with destructive behavior and painful, horrible acting out. There were times I wanted to leave, and my doctor would tell me, “you work so hard to see it, and then you throw it all away.” But I never thought of failure or of turning elsewhere. It was like birth . . . you are here and you learn to walk, to talk, and to live; and if it fails, you’re dead. So you just keep on working with the problems of life. That’s the way I felt about analysis. It was a total commitment. I had found a way that I could live, and if it wasn’t working for me, I just had to keep at it harder and more-never less-and it would work out. When the threads twist, you just have to resign yourself to a slower process of unwinding; the knots will come out, but it takes patience.

In fact, I do believe this attitude is essential for success. Otherwise, if you’re going to try intense treatment and “better” hasn’t happened in 6 months, then you have set yourself up

for failure. Theoretically, I suppose if I had felt my analysts weren’t good, I might have changed. But I never would have moved away from psychoanalysis. And I would be very cautious about faulting the analyst . . . not that it can’t happen that you have one that is not right for you or that you can’t have other reasons to change, but you must always examine your own motives. I have talked to people who tell me they have had analysis, and that it did nothing. Much of the time, I discover what they call analysis, and whom they call an “analyst” is far removed from a clinician with the kind of training I mean.

If I were not to choose analysis, the alternative for me would probably be destructiveness in one form or another. I always chose analysis. That, of course, may not be the rule for everyone, but childhood patterns are repeated, no matter how bad they may be. And if one’s background incorporates unhappy family dynamics, they will crop up over and over again without much change unless they are worked through, no matter how much your will is to have it otherwise. And that’s where you need the commitment . . . that no matter what it takes . . . you will stick at it and work it through . . . with a determination that this will not fail you, as the past so miserably did. Years of dedicated, applied, painful work with a good, trained analyst, and the reward is personal freedom. You can’t get any better than that.

Where can I find more information?

A trip to your local bookstore’s psychology section may lead you to all the reference material you need. Finding a doctor who specializes in anxiety in your community can answer many questions, as can contacting the Department of Psychiatry at your local medical school.

Selma’s comments:

When I first saw an analyst at 16 years old, I was convinced that no one but me had the depressive feelings and anxieties that I had. I inhabited a world that somehow had been selected by someone for me, or because of my own failures and inadequacies, was mine in which suffering, pity, and contempt were the reigning powers. Everyone else in the world was blessed with desirability and other attributes I could only jealously fathom. I was filled with self-loathing and isolation.

That actually changed the first time I went to my doctor’s office. He told me that I wasn’t alone and what I was suffering from, and although at that time not carefully delineated, it was common, not only to kids my age, but to people of all ages, and could be helped enormously. He said it was possible I could eat normally . . . as all I had in the 3 days before I saw him were some saltines and jam (not many), and even though I didn’t believe him for a minute, I was desperate and wanted to start. He also said astonishing things about girls and their mothers that piqued me as I intensely loved/hated my mother and felt her terrible problem in life was having an awful daughter like me. I was really hooked on these attractive options, and instantly felt not alone for the first time in over a year.

This analytic world became the passion of my life in some ways. I started to read. Someone named Freud had started it all, so I began with The Interpretation of Dreams. It is hard to explain the changes that came over me . . . the revelation that I was part of a very large world . . . not only I wasn’t alone, but what was going on in my head was universal. That was the first book and the beginning of a lifetime of reading books about psychoanalysis.

I began to have a deep understanding of insight, of its value and of its need. I could see how helpful it would be for so many people looking sincerely for answers to myriad problems of life, of self, and of family. If only people were alerted to it if it was available, affordable, accessible, and there was knowledge of it.

In all the years that I was in analysis, it was comforting to me to see the spread into so many areas of Freud’s emphasis on the influence of infancy and early childhood on adult life. So wherever I was able (there were many opportunities), as president of the PTA, through the boards I was on, conferences I directed, the synagogue and the church (as I had both), I invited analysts to speak on what was appropriate given the situation, but always dealing with children, family, or inner anxiety. These were always free programs, and the talk was always directed to a community audience and was not professional.

The turnouts were phenomenal. My earlier thoughts on my being unique in my set of problems seemed ludicrous. Everything I had suffered belonged to a never-ending, large world, and people were looking for help and answers. The question/answer periods were enlightening, stimulating, and very touching. The respect between the speaker and the audience members filled me with pride about the analytic world. These were wonderful times. Then something happened. Probably it was the continuing growth of the managed care phenomena, and cost effectiveness started somehow to be a part of the discussion of life’s problems. Insurance companies were directing what they would pay away from insight-oriented therapy to medication and quick diagnosis one could find in a manual that did away with the complexity of the mind and the individual.

I can’t go into all of these changes. There are many others, but for those who are looking for lasting meaningful change that will give them an opportunity for a life of freedom, creativity, satisfaction and happiness, psychoanalysis still exists and is as vital and significant as always, with competent, caring practitioners and a large following.

Whether it is called psychoanalysis or psychotherapy (by an analyst), it offers the route to know more about anxiety than any other way.

There are books, meetings, lectures, a lot of information on how to solve problems, live life, or raise children. In all of these venues there is also participation by an insight-oriented therapist or a psychoanalyst. I think the search is not complete or whole until this, too, is explored and considered. When learning more about anxiety and its cures, it is important to consider the distinction between that which will ease immediate pain (a symptom), that which will offer help directed to a cognitive learning self that may or not be applicable to a symptomatic area but will not hold up in the long run, and that which will bring the structural change so that it is changed forever. This is analytic knowledge, and there are proponents of all of this; I believe good self-education incorporates this analytic insight.

 

 Social Anxiety Documentary: Afraid of People (Video)

National Alliance for the Mentally Ill (NAMI)

American Psychological Association

Anxiety Disorders Association of America

American Psychoanalytic Association

American Psychiatric Association

HealthyPlace.com

What is Social Anxiety?

LIEBOWITZ SOCIAL ANXIETY SCALE (LSAS-SR)

Rating Scales

 Anxiety Disorders Self-Test for Family Members

How much anxiety is too much? Ask a family member to answer “yes” or “no” to the following questions by circling the appropriate answer next to each question; show the results to your health-care professional.

How can I tell if it’s an anxiety disorder?

Yes or No? Are you troubled by:

Yes No Repeated, unexpected panic attacks, during which you suddenly are overcome by intense fear or discomfort for no apparent reason, or the fear of having another panic attack?

Yes No Persistent, inappropriate thoughts, impulses or images that you can’t get out of your mind (such as a preoccupation with getting dirty, worry about the order of things, or aggressive or sexual impulses)?

Yes No Powerful and ongoing fear of social situations involving unfamiliar people?

Yes No Excessive worrying, for six months or more, about a number of events or activities?

Yes No Fear of places or situations where getting help or escape might be difficult, such as in a crowd or on a bridge?

Yes No Shortness of breath or a racing heart for no apparent reason?

Yes No Persistent and unreasonable fear of an object or situation, such as flying, heights, animals, blood, etc.?

Yes No Being unable to travel alone?

Yes No Spending too much time each day doing things over and over again (for example, hand-washing, checking things, or counting)?

More days than not, do you:

Yes No Feel restless?

Yes No Feel easily tired distracted?

Yes No Feel irritable?

Yes No Have tense muscles or problems sleeping?

Yes No Have you experienced or witnessed a traumatic event that involved actual or threatened death or serious injury to yourself or a loved one (for example, military combat, a violent crime or a serious car accident)?

Yes No Does your anxiety interfere with your daily life?

Having more than one illness at the same time can make it difficult to diagnose and treat the different conditions. Illnesses that sometimes complicate anxiety disorders include depression and substance abuse. With this in mind, please take a minute to answer the following questions:

Yes No Have you experienced changes in sleeping or eating habits?

More days than not, do you feel:

Yes No Sad or depressed?

Yes No Disinterested in life?

Yes No Worthless or guilty?

During the last year, has the use of alcohol or drugs:

Yes No Resulted in your failure to fulfill responsibilities with work, school, or family?

Yes No Placed you in a dangerous situation, such as driving a car under the influence?

Yes No Gotten you arrested?

Yes No Continued despite causing problems for you and/or your loved ones?

If you or someone you know would like more information on helping a family member, please go to the ADAA resource page at www.adaa.org.

 Generalized Anxiety Disorder (GAD)

Self-Test

How much anxiety is too much? If you suspect that you might suffer from generalized anxiety disorder, complete the following self-test by circling “yes” or “no” next to each question, and showing the results to your health-care professional.

How can I tell if it’s GAD?

Yes or No? Are you troubled by:

Yes No Excessive worry, occurring more days than not, for a least six months?

Yes No Unreasonable worries about a number of events or activities, such as work or school and/or health?

Yes No The inability to control the worry?

Are you bothered by any of the following?

Yes No Restlessness, feeling keyed up or on edge?

Yes No Being easily tired?

Yes No Problems concentrating?

Yes No Irritability?

Yes No Muscle tension?

Yes No Trouble falling asleep or staying asleep, or restless and unsatisfying sleep?

Yes No Does your anxiety interfere with your daily life?

Having more than one illness at the same time can make it difficult to diagnose and treat the different conditions. Illnesses that sometimes complicate anxiety disorders include depression and substance abuse. With this in mind, please take a minute to answer the following questions:

Yes No Have you experienced changes in sleeping or eating habits?

More days than not, do you feel:

Yes No Sad or depressed?

Yes No Disinterested in life?

Yes No Worthless or guilty?

During the last year, has the use of alcohol or drugs:

Yes No Resulted in your failure to fulfill responsibilities with work, school, or family?

Yes No Placed you in a dangerous situation, such as driving a car under the influence?

Yes No Gotten you arrested?

Yes No Continued despite causing problems for you and/or your loved ones?

If you or someone you know would like more information on generalized anxiety disorders, please go to the ADAA resource page on this topic at www.adaa.org.

Obsessive Compulsive Disorder (OCD)

If you suspect obsessive-compulsive disorder (OCD), the first step toward regaining control of your life is to seek help. Answer “yes” or “no” to the following questions by circling the appropriate answer, and show the test to your health-care professional at your first visit.

Could it be OCD?

Yes or No?

Yes No Do you have unwanted ideas, images, or impulses that seem silly, nasty, or horrible?

Yes No Do you worry excessively about dirt, germs, or chemicals?

Yes No Are you constantly worried that something bad will happen because you forgot something important, like locking the door or turning off appliances?

Yes No Do you experience shortness of breathe?

Yes No Are you afraid you will act or speak aggressively when you really don’t want to?

Yes No Are you always afraid you will lose something of importance?

Yes No Are there things you feel you must do excessively or thoughts you must think repeatedly in order to feel comfortable?

Yes No Do you have “jelly” legs?

Yes No Do you wash yourself or things around you excessively?

Yes No Do you have to check things over and over again or repeat them many times to be sure they are done properly?

Yes No Do you avoid situations or people you worry about hurting by aggressive words or deeds?

Yes No Do you keep many useless things because you feel that you can’t throw them away?

Having more than one illness at the same time can make it difficult to diagnose and treat the different conditions. Illnesses that sometimes complicate an anxiety disorder include depression and substance abuse. With this in mind, please take a minute to answer the following questions:

Yes No Have you experienced changes in sleeping or eating habits?

More days than not, do you feel:

Yes No Sad or depressed?

Yes No Disinterested in life?

Yes No Worthless or guilty?

During the last year, has the use of alcohol or drugs:

Yes No Resulted in your failure to fulfill responsibilities with work, school, or family?

Yes No Placed you in a dangerous situation, such as driving a car under the influence?

Yes No Gotten you arrested?

Yes No Continued despite causing problems for you and/or your loved ones?

Panic Disorder Self-Test

If you suspect you may be suffering from panic disorder, complete the following self-test by circling “yes” or “no” next to each question. Show the results to your health-care professional.

How can I tell if it’s panic disorder?

Yes or no? Are you troubled by:

Yes No Repeated, unexpected “attacks” during which you suddenly are overcome by intense fear or discomfort, for no apparent reason?

If yes, during this attack, did you experience any of these symptoms?

Yes No Pounding heart

Yes No Sweating

Yes No Trembling or shaking

Yes No Shortness of breath

Yes No Choking

Yes No Chest pain

Yes No Nausea or abdominal discomfort

Yes No “Jelly” legs

Yes No Dizziness

Yes No Feelings of unreality or being detached from you

Yes No Fear of dying

Yes No Numbness or tingling sensations

Yes No Chills or hot flashes

Yes No Do you experience a fear of places or situations where getting help or escape might be difficult, such as in a crowd or on a bridge?

Yes No Does being unable to travel without a companion trouble you?

For at least one month following an attack, have you:

Yes No Felt persistent concern about having another one?

Yes No Worried about having a heart attack or going “crazy”?

Yes No Changed your behavior to accommodate the attack?

Having more than one illness at the same time can make it difficult to diagnose and treat the different conditions. Illnesses that sometimes complicate an anxiety disorder include depression and substance abuse. With this in mind, please take a minute to answer the following questions:

Yes No Have you experienced changes in sleeping or eating habits?

More days than not, do you feel:

Yes No Sad or depressed?

Yes No Disinterested in life?

Yes No Worthless or guilty?

During the last year, has the use of alcohol or drugs:

Yes No Resulted in your failure to fulfill responsibilities with work, school, or family?

Yes No Placed you in a dangerous situation, such as driving a car under the influence?

Yes No Gotten you arrested?

Yes No Continued despite causing problems for you and/or your loved ones?

Phobia Self-Test

Phobias-illogical yet powerful fears-affect more than one in eight Americans at some time. Phobias are the most common kind of anxiety disorder. If you suspect that you might suffer from a phobia, complete the following self-test by circling “yes” or “no” next to each question. Show the results to your health-care professional.

How can I tell if it’s a phobia?

Yes or no? Are you troubled by:

Yes No Powerful and ongoing fear of social situations involving unfamiliar people?

Yes No Fear of places or situations where getting help or escape might be difficult, such as in a crowd or on a bridge?

Yes No Shortness of breath or a racing heart for no apparent reason?

Yes No Persistent and unreasonable fear of an object or situation, such as flying, heights, animals, blood, etc.?

Yes No Being unable to travel alone, without a companion?

Having more than one illness at the same time can make it difficult to diagnose and treat the different conditions. Illnesses that sometimes complicate anxiety disorders include depression and substance abuse. With this in mind, please take a minute to answer the following questions:

Yes No Have you experienced changes in sleeping or eating habits?

More days than not, do you feel:

Yes No Sad or depressed?

Yes No Uninterested in life?

Yes No Worthless or guilty?

During the last year, has the use of alcohol or drugs:

Yes No Resulted in your failure to fulfill responsibilities with work, school, or family?

Yes No Placed you in a dangerous situation, such as driving a car under the influence?

Yes No Gotten you arrested?

Yes No Continued despite causing problems for you and/or your loved ones?

Post-traumatic Stress Disorder Self-Test

If you suspect that you might suffer from posttraumatic stress disorder, complete the following self-test by circling “yes or “no” next to each question. Show the results to your health-care professional.

How can I tell if it’s PTSD?

Yes or No?

Yes No Have you experienced or witnessed a life-threatening event that caused intense fear, helplessness or horror?

Do you reexperience the event in at least one of the following ways?

Yes No Repeated, distressing memories and/or dreams?

Yes No Acting or feeling as if the event were happening again (flashbacks or a sense of reliving it)?

Yes No Intense physical and/or emotional distress when you are exposed to things that remind you of the event?

Do you avoid reminders of the event and feel numb, compared to the way you felt before, in three or more of the following ways:

Yes No Avoiding thoughts, feelings, or conversations about it?

Yes No Avoiding activities, places, or people who remind you of it?

Yes No Blanking on important parts of it?

Yes No Losing interest in significant activities of your life?

Yes No Feeling detached from other people?

Yes No Feeling your range of emotions is restricted?

Yes No Sensing that your future has shrunk (for example, you don’t expect to have a career, marriage, children, or a normal life span)?

Are you troubled by any of the following?

Yes No Problems sleeping

Yes No Irritability or outbursts of anger

Yes No Problems concentrating

Yes No Feeling “on guard”

Yes No An exaggerated startle response

Having more than one illness at the same time can make it difficult to diagnosis and treat the different conditions. Illnesses that sometimes complicate an anxiety disorder include depression and substance abuse. With this in mind, please take a minute to answer the following questions:

Yes No Have you experienced changes in sleeping or eating habits?

More days than not, do you feel:

Yes No Sad or depressed?

Yes No Disinterested in life?

Yes No Worthless or guilty?

During the last year, has the use of alcohol or drugs:

Yes No Resulted in your failure to fulfill responsibilities with work, school, or family?

Yes No Placed you in a dangerous situation, such as driving a car under the influence?

Yes No Gotten you arrested?

Yes No Continued despite causing problems for you and/or your loved ones?

Social Phobia Self-Test

Social phobia, or social anxiety disorder, affects more than 13% of Americans. It is a real and serious health problem that responds to treatment. The first step is seeking help. If you suspect that you might suffer from social phobia, complete the following self test by circling “yes” or “no” next to each question. Show the results to your health-care professional.

How can I tell if it’s social phobia?

Yes or no? Are you troubled by:

Yes No An intense and persistent fear of a social situation in which people might judge you?

Yes No Fear that you will be humiliated by your actions?

Yes No Fear that people will notice that you are blushing, sweating, trembling, or showing other signs of anxiety?

Yes No Knowing that your fear is excessive or unreasonable?

Does the feared situation cause you to:

Yes No Always feel anxious?

Yes No Experience a “panic attack,” during which you suddenly are overcome by intense fear or discomfort, including any of these symptoms?

Yes No Pounding heart

Yes No Sweating

Yes No Trembling or shaking

Yes No Shortness of breath

Yes No Choking

Yes No Chest pain

Yes No Nausea or abdominal discomfort

Yes No “Jelly” legs

Yes No Dizziness

Yes No Feelings of unreality or being detached from yourself

Yes No Fear of losing control, “going crazy”

Yes No Fear of dying

Yes No Numbness or tingling sensations

Yes No Chills or hot flashes

Yes No Go to great lengths to avoid participating in the feared situation?

Yes No Does all of this interfere with your daily life?

Having more than one illness at the same time can make it difficult to diagnose and treat the different conditions. Illnesses that sometimes complicate anxiety disorders include depression and substance abuse. With this in mind, please take a minute to answer the following questions:

Yes No Have you experienced changes in sleeping or eating habits?

More days than not, do you feel:

Yes No Sad or depressed?

Yes No Disinterested in life?

Yes No Worthless or guilty?

During the last year, has the use of alcohol or drugs:

Yes No Resulted in your failure to fulfill responsibilities with work, school, or family?

Yes No Placed you in a dangerous situation, such as driving a car under the influence?

Yes No Gotten you arrested?

Yes No Continued despite causing problems for you and/or your loved ones?

Anxiety Disorders in Adolescents: A Self-Test

How much stress or worry is considered too much? Complete the following self-test by circling “yes” or “no” next to each question. Show the results to your health-care professional.

Is it an anxiety disorder?

Yes or No? As a teenager, are you troubled by:

Yes No Repeated, unexpected “attacks” during which you suddenly are overcome by intense fear or discomfort for no apparent reason, or the fear of having another panic attack?

Yes No Persistent, inappropriate thoughts, impulses or images that you can’t get out of your mind (such as a preoccupation with getting dirty or worry about the order of things)?

Yes No Distinct and ongoing fear of social situations involving unfamiliar people?

Yes No Excessive worrying about a number of events or activities?

Yes No Fear of places or situations where getting help or escape might be difficult, such as in a crowd or on an elevator?

Yes No Shortness of breath or racing heart for no apparent reason?

Yes No Persistent and unreasonable fear of an object or situation, such as flying, heights, animals, blood, etc.?

Yes No Being unable to travel alone, without a companion?

Yes No Spending too much time each day doing things over and over again (for example, hand-washing, checking things, or counting)?

More days than not, do you:

Yes No Feel restless?

Yes No Feel easily fatigued or distracted?

Yes No Experience muscle tension or problems sleeping?

More days than not, do you feel:

Yes No Sad or depressed?

Yes No Disinterested in life?

Yes No Worthless or guilty?

Yes No Have you experienced changes in sleeping or eating habits?

Yes No Do you relive a traumatic event through thoughts, games, distressing dreams, or flashbacks?

Yes No Does your anxiety interfere with your daily life?

Anxiety Disorders in Children: A Test for Parents

If you think your child may have an anxiety disorder, please answer the following questions “Yes” or “No”. Show the results to your child’s health-care professional:

Yes No Does the child have a distinct and ongoing fear of social situations involving unfamiliar people?

Yes No Does the child worry excessively about a number of events or activities?

Yes No Does the child experience shortness of breath or a racing heart for no apparent reason?

Yes No Does the child experience age-appropriate social relationships with family members and other familiar people?

Yes No Does the child often appear anxious when interacting with her peers and avoid them?

Yes No Does the child have a persistent and unreasonable fear of an object or situation, such as flying, heights, or animals?

Yes No When the child encounters the feared object or situation, does he react by freezing, clinging, or having a tantrum?

Yes No Does the child worry excessively about her competence and quality of performance?

Yes No Does the child cry, have tantrums, or refuse to leave a family member or other familiar person when she must?

Yes No Has the child experienced a decline in classroom performance, refused to go to school, or avoided age appropriate social activities?

Yes No Does the child spend too much time each day doing things over and over again (for example, hand-washing, checking things, or counting)?

Yes No Does the child have exaggerated fears of people or events (e.g., burglars, kidnappers, car accidents) that might be difficult, such as in a crowd or on an elevator?

Yes No Does the child experience a high number of nightmares, headaches, or stomachaches?

Yes No Does the child repetitively reenact with toys scenes from a disturbing event?

Yes No Does the child redo tasks because of excessive dissatisfaction with less-than-perfect performance?