(CNN) — Generalized anxiety disorder is the single most common mental health diagnosis, and yet it’s still taboo to talk about it. I recently went public with a very personal essay about my battle with it, and in doing so, realized an awful lot of people have been aching for a chance to talk about their struggles.
After comments poured in through CNN.com, e-mails, Facebook, Twitter and other channels, CNN Living hosted a live Google Hangout to address some of the issues. Scott Stossel, author of “My Age of Anxiety: Fear, Hope, Dread, and the Search for Peace of Mind“; Daniel Smith, author of “Monkey Mind: A Memoir of Anxiety“; and psychiatrists Dawn M. Porter and Scott Krakower joined me for a robust, hourlong video chat about treatment, taboos, triggers and the breaking of bad habits.
Here are 10 things we learned from that conversation:
Military families may be especially susceptible to anxiety
Porter is a military spouse and treats people in the community. She says that anxiety — and stressors — are present and constant.
“There are a lot of issues that our families go through with every transition,” she said. “You’re moving every two to four years, depending on what your service member’s responsibilities are. The service member has to settle into a new position and figure his or her way out; the spouse or partner also has to navigate a new environment and connect with a new community. If there are children involved, they have to get settled into a new school.”
The general public isn’t aware of such adjustments, Porter said, making it difficult for military families to assimilate into life outside a base. “They don’t get that our children are struggling, and their children don’t pick up on it. They have their stability and structure and don’t bring the military families in — which makes it even more difficult.”
She said she believes her own experiences help make her a more effective therapist for military families.
Physical symptoms are par for the course, but they’ll pass
A viewer wrote in, describing “feeling like I am going to faint, my heart will race and I get hot. I went to the doctor and they ran blood tests. Now they are sending me to a cardiologist. After looking up my symptoms it kind of sounds like anxiety but I am not sure. Since I … went to the doctor I keep feeling this tight pressure in my chest and I keep crying for no reason. Does this sound familiar?”
Members of the panel all shook their heads emphatically. “That’s the remarkable thing about anxiety: It’s so embodied, such a physical experience,” said Smith, who has undergone botox injections to counter excess sweating.
Stossel, whose memoir vividly detailed gastric symptoms he’s suffers, said, “My physiology has commandeered my sympathetic nervous system.”
I also fight a rapidly beating pulse, twitching muscles and deeply painful acid reflux. These symptoms are no picnic — and sufferers and ER doctors often mistake them for a heart attack — but they’re not fatal.
Anxiety begets more anxiety
Krakower noted even seeing a specialist to deal with treatment can cause more stress. “We can’t rule out a medical problem, but that, in turn, can feed the anxiety.”
That response is “definitive of anxiety,” Smith said. “You’re anxious about something, which leads you to focus more attention on the feeling — which leads you to be more anxious. Before you can snap your fingers, you’re on that merry-go-round, which once it starts, can be inordinately difficult to jump off of.”
Stossel agreed the cycle is hard to break. “I know a lot about the neuromechanics and the physiology of panic,” he said. “I feel myself having anxious thoughts and I’ll tell myself, ‘You’ve been through this a million times, and this is probably a panic attack.’ More often than not I can tell myself that it’s just a panic attack … but every once in a while, I’ll think, ‘But this feels slightly different than the previous 782 times. Maybe I am having a heart attack!’ “
Medications aren’t one size fits all
People may not be able to benefit from talk therapy if they’re in a state of panic. “If the level of anxiety is very high, it may be necessary to bring that down so they can use some relaxing techniques,” Porter said.
Stossel started his journey with medication at age 11 or 12, using Thorazine in the 1980s. He’s studied all sides of the argument, from those who feel a “rapacious” pharmaceutical industry makes issues worse and prefer a med-free treatment, to physicians who believe that drug therapy should be the first recourse. His view falls somewhere in the middle.
“Medication can be part of a psychotropic arsenal,” he said, discussing one therapist who urged him to stop taking Xanax so he could address his anxiety directly and not mask the physical symptoms.
But a psychopharmacologist felt his physical symptoms were so extreme that unless he tamped those down, he couldn’t benefit from other coping techniques, according to Stossel.
“Some drugs have worked some of the time,” Stossel said. “I couldn’t have gotten through my book tour without benzodiazepines, but there are reasons to be wary of dependence, abuse and masking the symptoms but not treating the underlying source of the anxiety.”
Younger people may feel less stigma about mental health than their parents
“There’s more publicity about anxiety,” Krakower said, “and it’s becoming more acceptable in the community.”
But there are certain things to consider when dealing with children and adolescents, these experts said.
“You first have to work at trying to engage them. If they’re not on board, it’s not going to work,” he said.
Krakower, a child and adolescent psychiatrist, uses a two-pronged approach of cognitive behavioral therapy and gradual medication if needed. He said he pays close attention to which treatment is working best and tries to make younger patients feel comfortable with the process.
He also said some youths self-medicate by smoking pot, but the temporary relief often results in a loss of motivation at school.
Porter agreed that it’s important to relate to children and teens. “They’re very perceptive about if you’re really interested in helping them.” She said she also tends to steer clear of certain groups of medications with that age group, so these drugs don’t become a crutch in the midst of change, or trigger suicidal impulses.
She also cautioned parents against overloading children with too many activities, expectations and pressures. “They have no downtime to be themselves. How do we balance their lives?”
Cultural taboos can get in the way of people seeking help
“Especially in the African-American community, there are a lot of issues that we face,” Porter said. “There’s always the stigma, there’s always the feeling that you have to be twice as good to get half as much. Because of this, there’s always a fear that anything someone finds out about you will be used against you. We’re also a strong community, based in our religion. With that, there’s a feeling that if you have an issue, you need to take it to God.”
As a Christian, she said, she leans into her faith — but she also believes it’s God who brings people to a psychiatrist and provides the medication that helps people to do better or feel better. Porter said pastors, community groups and even celebrities are normalizing the notion of seeking help and encouraging people to share their own stories.
Anxiety can be the enemy of romance
In Smith’s research for “Monkey Mind,” he saw a pattern emerge when it came to love. “When you’re anxious, you tend to scan around for what may be causing it. And often you alight upon that person who is right next to you.”
In addition to assuming a relationship is the root of a problem, he noted some people often experience shame that their partners will see them as weak.
In his own life, Smith pushed away a partner, and then in midst of the resulting sadness, felt he needed her and pulled her back. “That speaks to the whole stigma,” he said, “the whole worry that if someone knows you are suffering from anxiety, they will consider you to be somehow less.”
Gender expectations take a toll
Writer Stossel was struck by the extra burden many men face when it comes to anxiety. “There’s a stigma around vulnerability,” he said.
“Women have higher rates of diagnosis of anxiety disorder than men do,” Stossel said. “That could be for temperamental reasons or for social reasons — because of glass ceilings or extra pressures. It could also be because it’s more acceptable for women to seek out treatment and accept a diagnosis. Whereas men have higher rates of alcoholism, and it may be that we’re all just trying to sublimate and are afraid to seek help.”
Krakower said he believes it’s important, when working with young, male patients, to understand they may feel more stigmatized by school and friends than their female peers. “It’s important to make them feel accepted in the individual therapy sessions and then teach them more ways to control their anxiety.” These may include learning relaxation techniques, or how to be more assertive and not feel so nervous.
Anxiety doesn’t have to define you, so make peace with it
Smith was diagnosed in college — by his mother, a therapist who specializes in anxiety — and he called the diagnosis a doubled-edged sword. “It’s helpful to name something, but at the same time makes you feel trapped in that particular diagnosis,” he said.
“It’s important not just to think of it as a disorder or a mental construct, but as an emotion — a universally held and rather important emotion. We need anxiety, and if we didn’t have it, we’d be hit by cars far more frequently,” Smith said. “You don’t necessarily want to banish your anxiety; you want it to be there to some extent but not rule your life.”
Stossel, now 44, spent the first 43 years of his life trying to hide his condition — before penning a wildly popular and public memoir about it. “There are times when the level of suffering (is) so high, not to treat it as an illness … is unfair and almost handicapping the therapist’s ability to treat it. Even then, I’ve had to come to terms with thinking of this as woven into my personality and part of my temperament, but not what completely defines who I am.”
It might not feel like it in the thick of things, but it’s possible to fight back
Porter starts by asking her patients to make a list of what relaxes them and what activities they enjoy. These might include exercising, taking a walk around the block, deep breathing, talking to family members or listening to music. When in the throes of a panic attack, they will have some solutions at the ready and can pick out which are the most effective in the moment.
Smith has found cognitive behavioral therapy effective in changing some of his patterns and also seeks peace through Buddhist meditation, and in particular Zen. Both methods focus on mindfulness and paying attention to thoughts that trigger anxiety.
“The one thing you’re not doing when you’re anxious is existing in the present moment,” Smith said.
Stossel recalled that when an excerpt of “My Age of Anxiety” ran in The Atlantic, strangers inundated him with advice to cut out gluten, sugar and caffeine, eat more fish oil and magnesium, try massages or yoga and smoke pot. But the things that sound the most banal are the most effective, he said.
“They’re the things that your internist and your mother and your grandmother told you,” he said. “Get enough sleep. It’s good for you physically; it reduces depression and anxiety.” He also swears by exercise, breathing techniques and cognitive behavioral therapy.
“So many of us with generalized anxiety disorder are gifted catastrophizers and worry that any decision we make or anything we enter into is going to be absolutely catastrophic and existentially damaging,” Stossel said.
“But if you actually think it through and imagine the worst thing that could happen, well, did anybody die? Is it really that bad? Then use that to try to calm yourself.”
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