Dr. Neal Ranen, M.D. Offers Anxiety Treatment in Baltimore

Fear serves as a filter that assists in the recognition of danger. It heightens the reflexes and increases mental alertness. The fear response was particularly important in the early days of humankind when there was a need to be vigilant for mortal threats, such as suddenly encountering a mountain lion. However, our anxiety system is not as well-adapted to the stressors of modern life. Although some degree of worry can be helpful (like not being too blasé about work deadlines) when fears present themselves constantly and evolve into unescapable alarm or a lingering worry, they can have a negative impact on everyday life. This is a sign or indication that one may be dealing with a form of anxiety or an anxiety disorder. Almost 30 million Americans suffer from disorders such as this, and more than 10 percent of the population experience severe symptoms of anxiety that are in one way or another connected to physical ailments. Anxiety is believed to an underlying factor in at least 20 percent of existing medical conditions in people who seek primary health care.

Anxiety manifests in a variety of different ways. For example, phobic disorders are out of the ordinary, horrific fears about a certain thing or object, places or social circumstances. Psychiatrists classify phobic disorders into different groups, such as social, specific or agoraphobia.

Social phobias are fears of an irrational nature that cause the person to avoid being in a particular situation where others may watch or notice them. This can include performance anxiety or phobia, but the social terminology describes signs that exceed simple nervousness prior to a performance in front of a group or crowd of people. People who combat this form of anxiety have a strong fear of people watching, and often judging, them when they are doing certain things. These can be simple things such as having a conversation with someone, checking out at the grocery store, ordering a coffee at Starbucks, eating in a restaurant or attending a fitness class. Social phobia can reach a point that makes it almost challenging for people to attend school, go to work or interact socially with others at all. These phobias occur with both women and men, typically occur after puberty and typically hit their peak after they turn 30 years of age.

Specific phobias are quite common. This particular disorder is reflective of its name, in that it is a fear that people may have of a specific object or situation. If the object of fear is something typical, the results can be devastating. This category generally involves a fear of animals such as snakes, cats, dogs or insects. Then there is a fear that some may have of being in closed spaces, also referred to as claustrophobia or a fear of heights, acrophobia. These phobias generally arise during the younger years and may at some point go away. However, if the phobia carries into adulthood, it tends to persist without treatment.

Agoraphobia literally translates into a fear of the marketplace. It is a fear and avoidance of public or crowded spaces or places from where the person feels they cannot easily exit or escape. It can be related to a fear of having severe anxiety or a panic attack outside of one’s safe zone, typically the home. This phobia occurs in women more than men and is the most impairing of the group. Those suffering from this phobia have a fear of being stuck or alone in a place from which they feel will be difficult to escape. They simply believe that there would be no help if they became entrapped or have a panic attack in a space or area. Of course, ironically, a person would be much better off falling ill around a group of people than alone at home. Misplaced fear of embarrassment over becoming ill or having an anxiety attack around others can be part of this. This group of people tries their best to avoid places with crowds such as sporting events, churches, movie theaters and other similar spaces. This causes them to miss out on several events or social engagements. They withdraw from social activities by avoiding them completely. It causes such a fear in them that they literally become a prisoner in their own home. If circumstances lead them into places they fear, they can be completely overwhelmed with distress. Rarely will they enter this type of environment alone and, rather, they are in the company of a friend or a family member.

Psychotherapy and medication are appropriate and effective treatments for excessive worry and phobias. Psychiatrists utilize special techniques that have been researched and proven to help those suffering from phobic conditions. These include forms of Cognitive-Behavioral therapy and Exposure/Response Prevention. Many patients undergo desensitization treatment with great results. Techniques such as deep muscle relaxation help those with phobias to detect and relieve anxiety. This is followed by mental relaxation. Relaxation shifts the nervous system from a baseline of hyper-arousal to a relaxed resting mode. Then, the person learns to overcome their fears through progressive exposure in imagination and then in real life. This is done gently to achieve a relaxed, non-anxious state at every stage. After several treatments, the circumstance or object that caused the fear to generate eventually diminishes and no longer provokes fear in the person. Eventually, people can learn to put themselves into a relaxation state at their will, even when out and about, or when faced with a stress or trigger. Interestingly, the Biathlon in the Winter Olympics is a great example of the power of relaxation training. These athletes spend a lot of time doing relaxation exercises to help slow their heart-rate when they transition from the cross-country skiing portion to target shooting. The slower heart rate allows for more accuracy by reducing the bobbing of the rifle scope.

Tendencies towards automatic negative thoughts and the beliefs that underlie them can also be explored.

As above, the combination of psychotherapy and medication (particularly non-habit-forming, non-addictive medication) can be highly effective. There are several medications that are proven treatments, and specifically FDA-approved, for Anxiety Disorders, including phobias. So, the judicious use of medication can be extremely helpful.

There are a variety of theories as to why phobias occur in people. Some studies support that there may be imbalances in the chemistry of the brain, while others propose that phobias may be the result of negative messages or a traumatic event from childhood that has been buried emotionally and mentally. Genetic factors have been demonstrated, and, as such, anxiety often runs in families. An individual’s disposition may also play a role. For example, many people are much more concerned with avoiding bad things happening or making mistakes, rather than being influenced by positive experiences or successes. Stress in life or a significant loss can lead to certain phobias also. It is imperative to seek medical attention when phobias occur and lead to excessive anxiety.

When seeing individuals, I sort all this out and design the optimal treatment approach — one that is best for them. Contact me, Dr. Neal Ranen, M.D. to set up an appointment for an evaluation.

This article was originally posted on drnealranen.com 2/28/2018

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