WHAT IS ANXIETY?

All people feel anxiety. Whether it is the butterflies in your stomach before you ask someone out on a date, or the rush of anxiety that propels you out the door when you are running late. Often these feelings of anxiety are uncomfortable, but anxiety is a normal part of being a human being.

In fact, anxiety, panic, and worry are all part of the way humans experience fear. Each of these aspects involves the anticipation of danger or threat. We define anxiety as a normal, innate emotional alarm response to the anticipation of danger or threat. This means that fear is part of our biological make-up as human beings. We don't learn how to become anxious--we are born with it because it helps us to survive. Anxiety serves as an "alarm" to protect us from harmful aspects of our environment. Taken together, this definition means that anxiety is an innate, protective response to our environment.

Panic is similar to anxiety, and we define panic as a normal, innate emotional alarm response to the perception of immediate danger or threat. Similar to anxiety, panic is triggered when the threat is immediate--a burglar breaking into your home would likely elicit panic, while the fear of such an event happening in the future would generate anxiety.

Worry is also a normal, adaptive response to threat. Worry is a mental strategy that is used to avoid future danger. Anxiety serves to notify us of an upcoming threat or danger, and worry stimulates us to find a solution to a problem or a way of escaping from the danger.

WHAT IS THERE TO FEAR?

If these feelings can be so uncomfortable, why do we have them? The answer is simple: protection! The body has developed anxiety, panic, and worry as a protective alarm system to aid in coping with potential threats and dangers.

This protective alarm system is even more amazing when you consider that the protective function really exists on two levels. We are set up to respond to threats in two ways: a "preparation" mode and a "reaction" mode.

The preparation mode, consisting of anxiety and worry, helps us prepare for future danger or helps us prepare for threats which may be delayed. In essence, this type of fear tells us "You are not in danger. . .YET! But let's prepare for what may lie ahead. "

The reaction mode is designed to help us cope with immediate threats, and it functions as an escape alarm. It is more intense and shorter-acting than anxiety and is designed to help us deal with immediate danger. While true panic only lasts a few seconds, it prepares us to get out of the way of danger. This is often referred to as a "fight or flight" reaction--being able to face the danger (fight) or run from it (flight).

Even in today's world, when we aren't likely to be chased by lions, tigers or bears, this alarm system still serves a useful function. Just imagine if you were crossing a street and suddenly a car sped toward you, blasting its horn. If you experienced absolutely no anxiety, it is likely that you would be killed. However, it is more likely that you would panic--feeling a rush of adrenaline--and would run to safety. The moral of the story: Even though fear isn't a pleasant emotion, it is necessary to our survival. Anxiety, worry, and panic are designed to protect us, not to hurt us!

HOW DO I KNOW IF SOMETHING IS WRONG?

It can be difficult to tell if your level of anxiety is too much. A good rule of thumb is "how much does this impair my life or keep me from doing the things I would like to do?" Remember, since we see anxiety as a normal part of life there are certain times when anxiety can actually be helpful. For example, research suggests that there is an optimal level of anxiety that contributes to positive test performance. Too much anxiety and you can't concentrate. But too little anxiety impairs performance as well. So feeling stressed about important upcoming events or in the face of challenging life events is not enough to diagnose an anxiety disorder. However, if anxiety is "ruining your life" or if you feel stressed out all the time, the following are some symptoms that indicate that you have "too much" anxiety:
- Anxiety Attacks
- Sleeplessness
- Muscle Tension
- Poor Concentration
- Physical Problems Such as Frequent Upset Stomach
- Irritability
- Fatigue
- Excessive Feelings of Embarrassment in Social Situations

It is important to remember that each one of these alone can make you feel terrible, but having an anxiety disorder means struggling with a variety of anxiety symptoms. In other words, your protective alarm is going off just a bit too often and too early!

WHAT CAN I DO ABOUT MY ANXIETY?

Fortunately, there are some incredibly effective treatments for anxiety disorders. We hope you will take some time to explore our site and find out more about current treatments, up-to-the-minute research, and information about anxiety disorders. If you are suffering from an anxiety disorder you are not alone--we're here to help! Please, email us at abhcfsu@psy.fsu.edu or call at (850) 645-1766 for more information.

AGORAPHOBIA

"The only thing we have to fear is fear itself--nameless, unreasoning, unjustified terror which paralyzes needed efforts to convert retreat into advance" ---Franklin D. Roosevelt

The central feature of Agoraphobia is anxiety about being in places or situations from which escape might be difficult or embarrassing, or where help might not be available in the event of having a panic attack or panic-like symptoms. Some situations people with Agoraphobia commonly avoid include:
- Public transportation
- Parking lots
- Marketplaces
- Bridges
- Shops
- Theaters
- Crowds
- Being outside of the home alone

Although agoraphobia can exist both with and without panic disorder, in a majority of individuals the restrictions in behavior occur as part of their fear of having a panic attack in an "unsafe" or public place. This can lead these individuals to severely curtail even everyday activities such as driving, working, going to stores, or simply leaving the house. Others can face their feared situation only with a trusted companion or "safe person."

Individuals with Agoraphobia avoid any situation where they fear they will harm or embarrass themselves, or in which they would be helpless should a panic attack occur.

DO YOU HAVE AGORAPHOBIA?

You can call our clinic for an evaluation that can determine whether you meet for these diagnoses. With proper treatment, individuals can learn to face their fears and can begin to engage in previously feared and restricted behaviors. For more information on treatments available at our clinic, please see the Treatment web page. Please, email us at abhcfsu@psy.fsu.edu or call at (850) 645-1766 for more information.

COMPULSIVE HOARDING

Compulsive hoarding is defined as the accumulation of and failure to discard large quantities of possessions resulting in incapacitating clutter. Once thought to be a rare phenomenon, compulsive hoarding is estimated to affect around 4-5% of the population. Although more data is needed, hoarding appears to run a chronic and progressive course with mild symptoms beginning around age 18. Severe hoarding can cause impairment across a variety of domains including social, occupational, and family. Hoarding has traditionally been viewed as a symptom or subtype of Obsessive Compulsive Disorder. However, current research suggests that hoarding may be a distinct disorder.

CAUSES AND TREATMENT FOR HOARDING

Compulsive hoarding is viewed as a multifaceted problem stemming from various information processing deficits (e.g. categorization, decision making, and attention deficits), extreme emotional attachments to possessions, and behavioral avoidance. Current cognitive behavioral therapy (CBT) based treatment approaches involve understanding the mechanisms by which thoughts and behaviors, particularly avoidance, maintain compulsive hoarding symptoms. Specific activities include identifying and challenging core beliefs about the nature and need for specific possessions in addition to addressing difficulties with discarding and excessive acquiring.

DO YOU HAVE PROBLEMS WITH HOARDING?

Do you often collect things you don’t need?
Do you often avoid throwing things away because you’re afraid you might need them later?
Are you bothered by the amount of clutter in your home?

Note: There are currently no accepted diagnostic criteria for compulsive hoarding within the Diagnostic and Statistical Manual for Mental Disorders, Fourth Edition, Text Revision (DSM-IV-TR). However, if you answered yes to any or all of these questions you could be experiencing problems with compulsive hoarding. To determine whether or not you are experiencing significant impairment from these symptoms please call our clinic for an evaluation with one of our mental health professionals.

GENERALIZED ANXIETY DISORDER

Generalized Anxiety Disorder (GAD) has been referred to as "the 'basic' anxiety disorder" by some researchers since many of the features of GAD are common across the anxiety disorders. As noted on the "What is Anxiety?" page, worry and anxiety are innate and protective mechanisms. GAD, however, is much more than just everyday anxiety and worry-it is characterized by chronic and exaggerated worry that interferes with daily functioning.

Individuals who suffer from GAD typically describe themselves as "worriers" who worry about "everything, all the time". Some individuals with GAD, however, simply worry about one or two concerns. Common worries are health, money, family, or work. In some cases though, the actual source of worry is difficult to pinpoint. The disorder is referred to as "Generalized" Anxiety Disorder because of the pervasiveness and lack of a specific target of concern. Although individuals with GAD may not always identify the worries as "excessive," they report subjective distress due to constant worry, have difficulty controlling the worry, or experience related impairment in social, occupational, or other important areas of functioning.

SYMPTOMS ASSOCIATED WITH GAD

The National Institute of Mental Health describes the symptoms of GAD in the following manner:

People with GAD can't seem to shake their concerns, even though they usually realize that their anxiety is more intense than the situation warrants. People with GAD also seem unable to relax. They often have trouble falling or staying asleep. Their worries are accompanied by physical symptoms, especially trembling, twitching, muscle tension, headaches, irritability, sweating or hot flashes. They may feel lightheaded or out of breath. They may feel nauseated or have to go to the bathroom frequently. Or they might feel as though they have a lump in their throat. Many individuals with GAD startle more easily than other people. They tend to feel tired, have trouble concentrating, and sometimes suffer from depression, too (Anxiety Disorders: Decade of the Brain, NIMH).

Please note that this information is not intended for use in self-diagnosis. If you think you may have GAD, please email us at abhcfsu@psy.fsu.edu or call at (850) 645-1766 for more information.

Unlike many other anxiety disorders, GAD is not generally associated with restricted impairment in social situations or in occupational settings. Individuals with GAD do not characteristically avoid certain situations as a result of their disorder. However, in severe cases it can be incredibly debilitating. Left untreated, it can lead to impairment in even the most daily activities.

FIND OUT MORE ABOUT TREATMENT

Cognitive behavioral therapy has been found to be very effective in treating GAD. For more information on treatments available at our clinic, please see the Treatment web page. Please, email us at abhcfsu@psy.fsu.edu or call at (850) 645-1766 for more information.

OBSESSIVE-COMPULSIVE DISORDER

Obsessive-compulsive disorder (OCD) is an anxiety disorder characterized by uncontrollable thoughts (obsessions) and ritualized behaviors (compulsions). Obsessions may either be senseless or frightening in nature (e.g., thoughts of germs, accidents, horrible events, or immorality), and compulsions are typically specific actions or rituals enacted to control the intrusive thoughts (e.g., excessive hand washing, checking behaviors, or specific rituals). Most often compulsions are meant to reduce the chance that something bad will happen, though sometimes they may be an attempt to make things feel "just right."

A LEADING CAUSE OF DISABILITY

The World Health Organization has identified OCD as one of the top ten leading causes of disability worldwide. In addition to being extremely disabling, OCD is also the fourth most frequently diagnosed mental disorder. In America alone, 3.3 million individuals have been diagnosed with OCD. The prevalence of OCD is approximately equal in males and females, and the first symptoms often start in late adolescence or early adulthood. OCD typically does not appear by itself, and is often accompanied by other disorders such as major depression, other anxiety disorders, eating disorders, or substance abuse.

COMMON FEATURES OF OCD

OCD has a number of variations or forms. Several common types of obsessions and compulsions that a person may experience revolve around the following themes:
- Cleaning/Washing
- Checking
- Ordering
- Counting
- Other (e.g., sexual, religious)

DO YOU HAVE OCD?

**Note:**
The questions below are not intended for the purpose of self-diagnosis. For a more detailed screening, please email the Anxiety and Behavioral Health Clinic at abhcfsu@psy.fsu.edu or call at (850) 645-1766.
Please answer YES or NO for the following questions. Base your answers on your experiences in the past month.

1. Do you have concerns with contamination, getting a serious illness, or spreading illness?

2. Do you repeatedly check household appliances, doors, or other objects?

3. Are you very concerned with keeping objects in perfect order and/or do you perform counting, arranging, or "evening-up" behaviors?

4. Do you perform excessive or ritualized washing/cleaning, grooming rituals, or checking for signs of illness?

5. Do you have personally unacceptable thoughts or repeated mental images?

The following question will refer to ALL of the repeated thoughts or behaviors identified in the preceding questions.

1. On average, how much time is occupied by these thoughts or behaviors each day?
NONE (0 hrs.) MILD (less than 1 hr.) MODERATE (1-3 hrs.) SEVERE (more than 3 hrs.)

2. How much do they interfere with school, work, or your social or family life?
NONE MILD MODERATE SEVERE

If you endorsed some of these symptoms for at least an hour a day, and they result in significant distress or impairment, you may be experiencing OCD. For a more detailed screening, please call the Anxiety and Behavioral Health Clinic at (850) 645-1766.

TREATMENT

Many individuals with OCD try to keep their disorder a secret, the result being that they suffer in silence and do not get the proper support or treatment. OCD is a chronic, often relapsing disorder, and if left untreated, it can consume an individual's life.

Research carried out over the past 30 years has aided in the development of effective treatments for OCD. Currently both medications and a specific type of cognitive behavioral therapy have been proven helpful in treating OCD. Several medications, all belonging to the selective serotonin reuptake inhibitor family, are useful in getting symptom reduction for some individuals with OCD. These include: clomipramine, fluoxetine, fluvoxamine, sertraline, and paroxetine. Exposure and response prevention is the specific type of cognitive behavioral therapy that has been shown effective with OCD. This therapy teaches individuals a variety of techniques with which they can avoid performing their compulsive rituals, as well as ways with which they can effectively deal with their anxiety and intrusive thoughts. The current consensus among researchers is that the combination of medications with cognitive behavior therapy is the most effective way of treating OCD. More information on treatments available at our clinic can be seen on the Treatment web page.

Please, email us at abhcfsu@psy.fsu.edu or call at (850) 645-1766 to find out more about our treatment programs!

PANIC DISORDER

People with panic disorder experience recurrent, unexpected, panic attacks. A panic attack can be described as an intense, sudden rush of physiological sensations (e.g., racing heart, difficulty breathing, sweating, chest pain). Panic attacks typically last for about 10 minutes, but in rare cases can last an hour or more. Because panic attacks tend to be unexpected, people with panic disorder worry that these attacks are an indication that something is wrong with them physically or mentally. In between attacks there is often intense anxiety about the risk of having another attack. This fear can lead an individual to avoid activities and restrict behaviors. In some cases, individuals can only perform certain activities in the presence of a "safe person", who can assist them in case of an attack.

PANIC ATTACK SYMPTOMS

Panic attack symptoms can include:
- Pounding/racing heart
- Sweating
- Trembling or shaking
- Shortness of breath
- Feelings of choking
- Chest pain or discomfort
- Nausea
- Feeling dizzy, unsteady, or faint
- Chills or heat sensations
- Numbness or tingling
- Feelings of unreality
- Fear or losing control or "going crazy"
- Fear of dying

Although many people experience these symptoms at some point in their lives, individuals with panic disorder live in fear of experiencing these symptoms and experience them frequently. For some individuals panic attacks may originally be cued by certain environmental features. Later, they might occur without any predisposing stress or identifiable cues. It is also possible to suffer from discrete panic attacks and not suffer from panic disorder. It only becomes a disorder when the individual suffers from recurrent and uncued attacks, begins to fear the possibility of having another attack, or fears the consequences of an attack (e.g., going crazy, having a stroke), and shows significant impairment in functioning.

DO YOU HAVE PANIC DISORDER?

Many of the symptoms associated with Panic Disorder are similar to those experienced in acute medical crisis, such as a heart attack, and individuals frequently seek immediate medical attention only to be told that their problems are psychological, not medical. Indeed, many individuals with panic disorder have had repeated medical tests and have sought several "second opinions" because it is difficult to believe that one can experience such intense symptoms and not have a medical illness. Unfortunately, many individuals with panic disorder also begin to "self-medicate" their anxiety through the use of alcohol and drugs.

If you suffer from frequent panic attacks and are very concerned about experiencing these symptoms, you may qualify for a diagnosis of Panic Disorder. You can call our clinic at (850) 645-1766 or email us at abhcfsu@psy.fsu.edu for an evaluation with one of our mental health professionals to determine whether you meet for this diagnosis.

FIND OUT MORE ABOUT EFFECTIVE TREATMENTS

Fortunately treatments for panic disorder are among the best researched and most effective types of therapy. Studies have shown that with proper treatment, 70-90% of panic disorder patients will show improvement.

Alternative medical treatments (i.e., medications) are also available and can be used in conjunction with psychological therapies. For many, significant improvement occurs within 6 to 8 weeks. For more information on treatments available at our clinic, please see the Treatment web page.

POSTTRAUMATIC STRESS DISORDER

Posttraumatic Stress Disorder (PTSD) can develop following a stressful or traumatic event, such as physical or sexual assault, combat exposure, a serious accident, or a natural disaster. Individuals may directly experience the event or witness it. During the event, the individual typically experiences strong feelings of horror, helplessness or fear. PTSD was originally thought to arise as a result of war trauma and was referred to as "shell shock." We now know that this disorder can arise from many different types of traumatic events. Individuals can develop PTSD at any age, including childhood.

People can experience a traumatic event without developing PTSD. Some studies suggest that up to 70% of the U.S. population will be exposed to traumatic stressors. A subset of individuals will develop Acute Stress Disorder, a more immediate reaction to a stressful event in which symptoms only last for 1 month. Symptoms of PTSD typically develop within 1 month, although some do not develop the disorder for a year. Other individuals develop symptoms of PTSD, but not the full-blown disorder. Certain groups of individuals have elevated risk for PTSD, such as women. Additionally, individuals suffering multiple traumas, intense trauma, and unpredictable/uncontrollable trauma may be at a greater risk for developing PTSD symptoms.

PTSD SYMPTOMS

Individuals with PTSD repeatedly relive the traumatic event in various forms. Some can experience repeated, intrusive memories of the trauma. Others may experience nightmares that remind them of what happened. Individuals may experience flashbacks: sensory experiences during which the individual feels as if they are "reliving" what happened, and may even lose awareness of their current surroundings. Oftentimes, those with PTSD may be triggered by people, places, or situations that remind them of the trauma, leading them to feel very upset and anxious, and/or experience symptoms such as increased heart rate, shakiness, and trouble breathing. Individuals with PTSD attempt to avoid thinking about or discussing the trauma, and may also avoid situations or experiences that remind them of it.

Individuals suffering from PTSD may also experience changes in mood, such as feeling detached or numb, or lose pleasure in previously enjoyable activities. Other common mood symptoms include emotional numbing toward positive events and an increased reactivity toward negative events. Many feel as if they cannot trust others, that the word is extremely dangerous, or may blame themselves for what happened. Those with PTSD can also develop trouble sleeping, feel like they must always be watchful or "on guard," or may startle easily. Some can also become irritable and have angry outbursts.

Often individuals with PTSD have symptoms of other disorders, particularly depression, substance abuse, or other types of anxiety. Often individuals "self-medicate" their feelings with alcohol or other substances. This can lead to a temporary dulling of the anxiety, but can lead to a "rebound effect," or intensification of this anxiety, after discontinuing the drugs.

COURSE AND TREATMENT

The course of PTSD differs across individuals. Some individuals recover within six months, others show a more chronic course, lasting years.

Cognitive behavioral treatments have been shown to be effective for treating PTSD symptoms.

Please, email us at abhcfsu@psy.fsu.edu or call at (850) 645-1766 to find out more about our treatment programs.

SOCIAL ANXIETY DISORDER

Social anxiety disorder refers to a marked and persistent fear of being negatively judged by others. Anxiety may be experienced in a variety of social situations including, but not limited to:
-Public speaking
-Participating or presenting at meetings
-Talking with a group of people or authority figures
-Having one-on-one conversations
-Being assertive
-Dating or attending parties
-Writing or eating in front of others

Before and during the social situation, individuals with Social Anxiety Disorder may experience physical symptoms of anxiety, such as blushing, sweating, trembling, nausea, rapid heart rate, and shortness of breath. After the social situation, they may brood over what happened, picking apart the details of the event. Many people feel anxious in these situations from time to time. However, individuals with Social Anxiety Disorder experience significant distress and impairment in their daily lives as a result of their anxiety surrounding social situations.

Individuals with Social Anxiety Disorder avoid social situations or endure them with significant distress, and have done so for longer than 6 months. The anxiety significantly interferes with daily functioning, job performance, or social life. Sometimes, individuals may not even recognize that their anxiety is excessive or unreasonable, but may be told by others. Individuals with Social Anxiety Disorder may find it difficult to finish their education, interview for jobs, and have friendships or romantic relationships as a result of their anxiety.

RESEARCH

Social Anxiety Disorder is the third most common psychiatric disorder in the United States. Approximately 13% of people in the United States have this condition at some point in their lives. Social Anxiety Disorder typically onsets in childhood or adolescence. If untreated, Social Anxiety Disorder typically worsens with time. Also, individuals with Social Anxiety Disorder are at greater risk for depression, alcohol and drug abuse, and suicide, even more so than those with other anxiety disorders.

TREATMENT

Two main approaches have been proven effective to treat Social Anxiety Disorder: Cognitive behavioral therapy and medication. The ABHC offers cognitive behavioral therapy for social anxiety disorder. Cognitive behavioral therapy helps individuals change the way they think about situations and develop more helpful strategies to cope with anxiety. Medications, such as antidepressants, are prescribed for social anxiety disorder. Consult your physician about medication for Social Anxiety Disorder.

For more information on treatment programs for Social Anxiety Disorder offered at the ABHC, please see the Treatment page, email us at abhcfsu@psy.fsu.edu or call us at (850) 645-1766.

Please see the Research page for more information about current studies being conducted in the ABHC.

SPECIFIC PHOBIA

DO SNAKES FREAK YOU OUT? DO YOU HATE HEIGHTS?

If so, you might have a specific phobia. Everyone is afraid of something, but phobias are excessive and persistent fears that are specific to certain objects or situations. To most people these fears seem irrational, while others cannot seem to face their fears or overcome them.

Approximately 1 in 10 individuals suffer from phobias. Interestingly, these appear to cluster around particular "themes", and there are many common phobias. The most common are listed below:
- Animal - Dogs, spiders, snakes
- Natural Environment - Storms, heights, water
- Blood-Injection-Injury - Seeing blood or receiving an injection
- Situational Type - Bridges, tunnels, elevators, enclosed places

TREATMENT

For many individuals the phobic stimulus is easy to avoid. You don't like snakes? Well, move to a city and you won't have to worry about it. Don't like dogs? Keep a cat! When the feared object is easy to avoid, people with phobias may not feel they need treatment. In certain cases, however, specific phobias can become impairing. Individuals may go to excessive lengths to avoid exposure to the feared object or situation. In these cases, treatment is recommended. This is particularly important because individuals with a single Specific Phobia are likely to develop additional phobias within the same subtype. In other words, an individual with a fear of bridges is likely to also develop a fear of tunnels and elevators.

Cognitive behavioral therapy is extremely effective in treating specific phobias. For more information on treatment programs for specific phobias, please see the Treatment page, email us at abhcfsu@psy.fsu.edu or call us at (850) 645-1766.

INSOMNIA

Insomnia is a sleep disorder defined by difficulty falling asleep, staying asleep, or waking up too early. Although everyone experiences these problems from time to time, for those with insomnia, these problems become almost nightly occurrences, and are often accompanied by daytime problems. For example, many people with insomnia feel fatigued during the day, have trouble concentrating, feel irritable, stressed, and have trouble doing their work. Insomnia is also linked to worsening in mood, anxiety symptoms, and physical health.

DO YOU HAVE INSOMNIA?

Do you have trouble falling asleep or staying asleep? Do you wake up early and can't get back to sleep? Do your sleep problems bother you? Do your sleep problems interfere with your daily functioning (e.g., feeling fatigued, difficulty functioning at work, concentrating, and remembering things, or affect your mood)? If you answered yes to any of these questions, you may have insomnia disorder. Insomnia disorder is diagnosed with an interview which rules out other sleep disorders.

TREATMENT

Insomnia is treated with two main approaches: medication and cognitive behavioral therapy for insomnia (CBT-I). CBT-I is a brief psychological treatment that may be more effective at treating insomnia in the long-term compared to medications. You will learn how to change your thoughts and behaviors related to sleep to help you improve your sleep. For more information on treatments available at our clinic, please see the Treatment web page. Please, email us at abhcfsu@psy.fsu.edu or call at (850) 645-1766 for more information.