Anxiety and/or depression are among the most common mental health concerns. Given the coronavirus (COVID-19) pandemic, anxiety and/or depression is even more likely for many people. Sometimes people are aware that they feel anxious or depressed, but often they are not aware that the reason they don’t feel good or that they feel off is because they have anxiety and/or depression. 

Anxiety and depression can arise from a variety of sources including, but not limited, to genetic predisposition and situation-specific. The good news is that mental health care has years of research and evidence-based approaches to treating anxiety and depression. In most cases, the symptoms can be managed effectively, if not put into complete remission. 

At Kimberly Keiser & Associates, while we are specialized in treating clients seeking care in sex therapy, trauma therapy and couples work, almost all clients we work within these areas also display symptoms of anxiety and depression when their therapy begins. We have many useful and evidence-based treatment approaches to treating anxiety and depression that we’d like to share with you. 

But first, let’s learn more about what these symptoms actually are. 

Anxiety

Prevalence

There are many different types of anxiety disorders, but all share common characteristics. The National Institute of Mental Health (NIMH), provides prevalence rates for US adults 18-years or older on the following types of anxiety: panic disorder, generalized anxiety disorder, agoraphobia, specific phobia, social anxiety disorder (social phobia), post-traumatic stress disorder, obsessive-compulsive disorder, and separation anxiety disorder.

• An estimated 19.1% of U.S. adults had any anxiety disorder in the past year.

• The past year prevalence of any anxiety disorder was higher for females (23.4%) than for males (14.3%).

• An estimated 31.1% of U.S. adults experience any anxiety disorder at some time in their lives.

The degree to which adults with anxiety are impaired differs. The NIMH found that:

• An estimated 22.8% had serious impairment

• An estimated 33.7% had moderate impairment

• A majority of people with any anxiety disorder experienced mild impairment (43.5%)

Symptoms

Symptoms of anxiety can vary tremendously and often people are not aware that their physical, emotional and cognitive experience is actually anxiety. 

Mental health providers can go a long way towards educating clients about why they don’t feel good. Diagnosing anxiety disorders based on symptoms is actually quite helpful because it sets the stage for a clear treatment strategy. 

Symptoms of anxiety can include any of the following alone or in combination:

• Anxiety in specific situations, e.g. testing, public speaking

• Anxiety in-person relationships

• Generalized anxiety in any context

• Feelings of depression, hopelessness, powerlessness, and low self-esteem

• Hostility, anger, irritability, resentment

• Phobias and fears of specific things

• Obsessions and unwanted thoughts

• Muscular tension

• High blood pressure

• Headaches, neck aches, backaches

• Indigestion, irritable bowel, ulcers, or chronic constipation

• Muscle spasms or tics

• Fatigue

• Insomnia or sleeping difficulties

• Obesity

• Physical weakness

• Job stress

• Chronic pain or illness

As you can see, anxiety can manifest in the cognition, or thoughts, and also in the physical body. Some people only have anxious thoughts, others may have only physical symptoms of anxiety, while others may exhibit both.

Diagnosis

The Diagnostic and Statistical Manual of Mental Disorders, 5th Edition (DSM-5), a manual by the American Psychiatric Association (APA), categorizes the symptoms of anxiety into different diagnoses. The APA is a useful resource for quickly understanding the differences between the different diagnostic types of anxiety:

Generalized Anxiety Disorder (GAD)

• Generalized anxiety disorder occurs when a person has persistent and excessive worry that works in tandem with physical symptoms, e.g. restlessness, feeling on edge or easily fatigued, difficulty concentrating, muscle tension body aches, high blood pressure, problems sleeping, etc. People with GAD often find themselves suffering and worried about almost anything in their lives.
  

Panic Disorder

• A person with panic disorder has panic attacks, which have more extreme thoughts and feelings associated with anxiety, including: 

  • Palpitations, pounding heart, rapid heart rate or chest pain

  • Sweating

  • Trembling or shaking

  • Feeling of shortness of breath or smothering sensations

  • Feeling dizzy, light-headed or faint

  • Feeling of choking

  • Numbness or tingling

  • Chills or hot flashes

  • Nausea or abdominal pains

  • Feeling detached

  • Fear of losing control

  • Fear of dying

• It is not uncommon for people who have panic attacks to believe that they are having a heart attack.
  

Phobias, Specific Phobia

• A specific phobia is an extreme and persistent fear of a specific object, situation or activity that is generally not harmful, for example, heights, snakes, etc. While people with phobias often intellectually understand that they have irrational thoughts, they can’t stop the associated distress and seek to avoid whatever they are phobic of.
  

Agoraphobia

• Agoraphobia is the fear of not being able to get out of a situation and is usually accompanied by panic symptoms and is problematic to overall functioning. Untreated agoraphobia can become so serious that a person may be unable to leave the house. Common situations in which a person has symptoms include:

  • Using public transportation

  • Being in open spaces

  • Being in enclosed places

  • Standing in line or being in a crowd

  • Being outside the home alone
    

Social Anxiety Disorder (previously called social phobia)

• A person with social anxiety disorder has significant anxiety in social situations and in being around and talking to others. Common examples are extreme fear of public speaking, meeting new people or eating/drinking in public. Social anxiety can lead to issues daily functioning and may result in the person isolating themselves or avoiding social situations.
  

Separation Anxiety Disorder

• A person with separation anxiety disorder is fearful or anxious about separation from who they are attached to. The feeling is beyond what is appropriate for the person’s age and causes problems functioning. 

Treatment

Many providers will use a variety of techniques in combination with each other. At Kimberly Keiser & Associates, we tend to utilize the following approaches.

• Coordination with a medical provider to rule out any physical cause of the anxiety. 

• Working with the client on stabilizing basic physiological functioning by creating good lifestyle plans around diet, sleep, exercise, and social contact. 

• Utilizing Cognitive-Behavioral Therapy (CBT) to educate a client on the nature of the types of thoughts the anxious mind creates and how to learn to think more rationally to lower anxiety. 

• Utilizing Dialectical Behavioral Therapy (DBT) to teach a client how to better regulate their emotions, manage interpersonal relationships and practice mindfulness.

• Teach assertiveness training to clients whose anxiety is due to a lack of assertiveness in interpersonal relationships. 

• Teach mindfulness meditation, progressive relaxation, and breathing exercises to give the client additional coping skills to help soothe an anxious system. 

• Provide psychodynamic psychotherapy with the client to explore deeper causes and/or meaning found in the anxiety.

• If anxiety exists as part of another mental health issue, e.g. Post-traumatic Stress Disorder (PTSD), utilize trauma therapy interventions like Internal Family Systems (IFS) or Eye Movement Desensitization Reprocessing (EMDR). 

There is no one-size-fits-all approach to treating anxiety, but our depression and anxiety therapists have a vast and effective tool kit to successfully treat anxiety. 

As mental health counselors in Sioux Falls, our office works to offer healing, restoration, and support for every journey in life. We offer in-office appointments as well as online tele-health video sessions if you are further away or not ready to leave the house.