By: Dr. Gregory Popcak
Sure I’m Stressed, But Isn’t Everyone? Anxiety vs. Stress.
“I just feel like everything is piling up on me.” Says Melissa. “Work is crazy right now, and of course the family doesn’t stop needing me just because I’m busy at the office. Then there’s all the stuff going on with my brother…. Sometimes I can’t catch my breath. I mean, I literally can’t catch my breath. I’ve got this constant tightness in my chest, my stomach’s a wreck and I’m just on edge all the time. Somehow I’m going to just have to find the strength to deal with it. Everybody’s stressed these days, I guess. This isn’t anything that a million other people aren’t going through.”
Melissa is right about one thing. Everyone is stressed out today. The fact is stress isn’t all bad. In small doses, stress helps us think more quickly and problem-solve more efficiently, especially when we have to think on our feet in a tough situation. But sometimes, if we carry around too much stress for too long (e.g. marriage and family problems, work & financial problems, personal struggles), or even if we go through a single, particularly traumatic, stressor (e.g., violent death of a loved one, serious accident, victim of a crime, childhood abuse/neglect, fighting in a war) the parts of our brain that God made to warn us about stressors can become hyperactive. Under extended stress, the chemicals in our brain that helpfully tell us to, “Pay attention!” to problems can overstimulate the amygdala (the brain’s fire alarm center). When this happens, the amygdala can, in effect, get a chemical burn. It becomes hypersensitive to stress, “goes off” too easily, and becomes difficult to turn off again. When all this happens we may develop one of several types of anxiety disorders such as Generalized Anxiety Disorder, Panic Disorder, Social Anxiety Disorder, or Post-traumatic Stress Disorder.
Anxiety Disorders: What Do They Look Like?
Generalized Anxiety Disorder (GAD) is best known for an ongoing, “free-floating” sense of anxiety that makes it difficult to function at your best. The anxiety associated with GAD is known as “free-floating” because it can be difficult for a person with GAD to say what he or she is anxious about. In fact, the person with GAD might feel like his or her life is “just fine” and not be consciously stressed-out about anything. This may be because the person has failed to appreciate how much a particular stressor has worn out the brain’s stress-management systems, or because they have lived with the stress for so long it seems normal. Regardless, the GAD sufferer experiences excessive worry more days than not over a period of several months. Additionally, people with GAD may become easily fatigued and have difficulty concentrating or experience their mind going blank. They may be irritable and experience muscle tension and/or sleep problems (either difficulty falling or staying asleep, or restless unsatisfying sleep). Anyone who has had at least three of these symptoms for several months (4-6) should seek professional help.
Panic Disorder is similar to GAD in that the person suffering from it might have a hard time identifying what he or she is stressed about. But Panic Disorder is marked by intense bursts of crippling anxiety known as “panic attacks.” The person with panic attacks may feel like he or she is having a heart attack; experiencing a sense of a rapid heart rate, dizziness, sweating, nausea, and muscle tension in the head, chest, and elsewhere. Panic Disorder is often discovered when a person goes to the hospital thinking that he or she is experiencing a heart attack only to find that testing reveals no heart troubles whatsoever. In addition to the panic attacks, a person with panic disorder may become constantly worried about having additional attacks, they may worry about losing control or “going crazy,” and they may even avoid certain places in an attempt to eliminate possible causes of the panic attacks. When this happens, a person can develop “Panic Disorder with Agoraphobia” which can result in being afraid to leave the house altogether.
Social Anxiety Disorder or SAD occurs when a person experiences significant, debilitating, anxiety related to some specific social function or activity. Eating in public, being in large or packed crowds, or engaging in other common, public, behaviors can be extremely stressful–even impossible–for the person with SAD. Even though they know their fears are unreasonable, they may work very hard to avoid social interaction, even if that means missing out on job opportunities or important family activities. Unlike with GAD and PD, people with Social Anxiety Disorder (aka “Social Phobia) know exactly what they are anxious about. They just feel powerless over their reactions. Someone who is experiencing these symptoms for several months (4-6+) or whose work or family life is being seriously affected should seek help.
Post-Traumatic Stress Disorder (PTSD) can occur when a person has experienced a single, catastrophic trauma (e.g., a serious car accident or physical/sexual assault), or a prolonged exposure to a traumatic environment (abuse, war). PTSD is characterized by recurring, intrusive memories of the traumatic event. Sometimes it can even feel like it’s happening all over again. The event may pre-occupy a person’s dreams and thoughts as well, although PTSD sufferers often work hard to avoid discussing the trauma or dealing with any situations that remind them of the trauma. People with PTSD may also experience extreme irritability, sleep problems, and exaggerated startle responses since they are constantly on alert less some terrible thing happen to them. A person experiencing any of these symptoms should seek professional help immediately.
Who Gets Anxiety Disorders?
In any given year about 20% of adults in the US experience one type or another of anxiety disorder so if you do have an anxiety disorder, you’re in good company. The good news is that up to 80% of people who seek treatment for anxiety disorders get better. Anxiety disorders are highly treatable and new, more effective ways to help people are being developed every day. If you are suffering with an anxiety disorder, the best thing to do is to seek help today.
People of faith often feel guilty for being anxious. They wonder if perhaps they are not praying hard enough or not trusting God enough. The truth is, Christians get anxiety disorders at roughly the same rate as everyone else. This should not be a surprise. After all, Christians catch cold as often as everyone else and get cancer or heart disease or high blood pressure at the same rate as everyone else. No one thinks of these things as spiritual failings. Remember, anxiety disorders are what happen to a person when the brain’s fire-alarm center–the amygdala–gets a “chemical burn” from bathing too long in stress chemicals, making it hypersensitive and over-reactive to new problems. Anxiety Disorders are not a failure of character or spiritual maturity. They are what happen when the brain’s stress-warning systems become overwhelmed and hyper-activated.
How Are Anxiety Disorders Treated?
Research shows that the treatments that work best for anxiety disorders are psychotherapy and/or medication. Most studies indicate that, especially for more serious anxiety disorders, recovery is quickest and strongest for those who receive both medication and psychotherapy. Let’s take a brief look at each.
Many people are confused about psychotherapy. How is it different than “just talking?” Even more importantly, if anxiety is caused by the wearing out and overstimulation of the body’s stress-warning systems, how can talking about your feelings help heal the body?
The truth is, just talking about your problems in any old way won’t necessarily help anything. In fact, studies show that there are some ways of talking about your problems that can make them infinitely worse. But mental health professionals have learned special ways to talk about problems–and teach clients techniques to work through problems–that have been shown to actually change the way the brain physically processes stress. Recent studies employing electro-encephalogram (EEG) technology shows that in as little as 12 weeks, psychotherapy alone changed the electrical patterns in the brains of anxious patients and enabling their brains to process stress more like people who do not suffer from anxiety disorders.
Well trained mental health professionals do not only encourage you to talk about your problems, they teach you to deal with stress in new ways and use techniques that can improve functioning in the stress-management and problem-solving parts of your brain.
Just like going to physical therapy after an injury can teach you exercises that can restore physical functioning, psychotherapy teaches you mental exercises that can restore functioning to the stress-management and problem-solving areas of the brain that have been affected by anxiety. In a very real sense, psychotherapy may be thought of as physical therapy for the brain.
There are many types of psychotherapy, but research has identified two types of therapy that are most effective in helping your brain recover from the wear and tear of anxiety: Cognitive-Behavioral Therapy and Mindfulness-Based Therapy (also known as Acceptance and Commitment Therapy).
Cognitive-Behavioral Therapy (CBT) helps you identify the unhealthy thinking patterns that make your brain work harder than it has to when faced with problems and stress. The therapist will also recommend changes in the way you act in stressful situations (and around stressful people) so that your brain can bounce back from these situations quickly and efficiently. Research shows that learning these mental and behavioral techniques may help both heal the damage stress has done to your brain and make your more stress-resistant in the future.
A second research-based therapy for anxiety disorders that is called Mindfulness-Based Therapy–MBT (or Acceptance and Commitment Therapy–ACT). Unlike Cognitive Behavior Therapy, which teaches you techniques to take control of the anxiety and reduce it, MBT/ACT teaches you techniques that enable you to, essentially, step outside of the anxiety and consciously redirect your emotional energy into productive activities. Where CBT is like boxing, in that it tries to confront and defeat anxious thoughts, ACT is more like Judo, which uses anxiety’s energy against itself, causing it to evaporate. Both types of therapy have much clinical and brain-based research supporting their effectiveness at both decreasing anxiety and changing the way the brain processes stress.
Whichever type of therapy is best for you, psychotherapy is much more than “just talking” with someone about your problems. It is a highly sophisticated process facilitated by a licensed professional that acts, in a sense, as physical therapy for the brain, restoring the brain’s ability to manage-stress, problem-solve, create emotional balance and a community of supportive relationships.
In addition to psychotherapy, medication is another common way of responding to anxiety disorders. In fact, most studies indicate that medication combined with psychotherapy is the most effective treatment. You should think of anxiety medication in a similar way as you might think about medication for high blood pressure. Medication can control high blood pressure, but in most cases, only lifestyle changes can cure it. In the same way, medication for anxiety disorders can control depressive symptoms, but in most cases, if not all, a person will also need to make lifestyle changes to heal from anxiety and keep it away. There are several different types of medication for anxiety disorders including, Anti-Anxieties (Benzodiazepines and Buspirone), and Anti-Depressants (SSRI’S and SNRI’s).
Anti-Anxiety Drugs come in two basic varieties: Benzodiazepines and Buspirone. Benzodiazepines are fast-acting drugs (about 30 min from ingestion to effect) that boost the effectiveness of the body’s calm-down chemical, GABA. Benzodiazepines supercharge GABA’s ability to soothe the irritated amygdala (sort of like applying numbing cream to that metaphorical chemical burn we discussed earlier). The downside is that these drugs have side-effects that include tiredness, fuzzy thinking, dizziness, slurred speech and other similar problems. You shouldn’t drive a car or operate machinery while on them. They can be habit forming.
By contrast, Buspirone, functions as a slower-acting anti-anxiety drug. It is thought to work by decreasing the amount of brain-agitating chemicals produced under stress. It can be about 2 weeks before the person taking Buspirone begins to feel better, and though it does have side effects like nausea, dry mouth, and dizziness, it does not cause drowsiness or impaired thinking. There is much less of a risk of dependency or withdrawal symptoms than with benzodiazepines.
Some Anti-Depressants are also used to treat anxiety disorders, but it can take 4-6 weeks before the patient will notice any change. These drugs (SSRI’s and SNRI’s like Paxil, Celexa, and Lexapro) are thought to work by boosting the level of the body’s stress-management and feel-good chemicals. These drugs are not habit forming, but there can be serious withdrawal symptoms for people who quit cold-turkey. Never stop taking any medication without consulting with your physician.
If you are struggling with anxiety, it is important to talk to a mental health professional to evaluate all your treatment options and design the best course of treatment for you.
Prayer and the Sacraments
Taking advantage of psychotherapy or medication does not mean that a person should neglect spiritual remedies. Our rich spiritual tradition as Catholics can be a great source of both comfort and healing. Don’t ever hesitate to ask for the intercession of pastors and other mature Christians. Dive into scripture, drawing encouragement from those versus that remind us of God’s providence and constant care (e.g., Mt 6:31-32; Phil 4:6-7; Phi 4:19, etc.).
Another source of great strength and healing are the Sacraments of Healing: Confession and Anointing of the Sick. Some people might be surprised by the encouragement to use confession. After all, anxiety is not a sin, nor are anxious people sinning by being anxious! But when we are anxious it is easy to give into things that are sins such as bad habits related to self-comforting, lashing out at others, or becoming too self-focused. As we receive the grace of confession to overcome anxiety’s negative influence in our lives and relationships, we can feel stronger and more confident in our ability to cooperate with God’s grace and achieve healing of body, mind and spirit.
Second, although anxiety disorders are an illness, most people don’t think of taking advantage of Anointing of the Sick to assist them in the healing process. Receiving this sacrament as a person struggling with an anxiety disorder is an important way to encounter God’s healing grace in action. A person may receive Anointing of the Sick as often as he or she feels the need for it. Through all the sacraments, we encounter the saving and healing actions of Christ. Let our Lord be a partner in your recovery.
Can’t I Just Talk to My Priest?
It is always good when a person suffering with anxiety receives support from his or her pastor, but people should never confuse talking with their priest with psychotherapy. Both can be helpful, but they are not the same. Remember, psychotherapy is, in essence, physical therapy for the brain. Unless your pastor has been trained in those techniques that actually change the way your brain functions under stress, then you are not getting therapy by talking to your priest about your anxiety any more than you would be taking medicine by talking to your pastor about your flu. Anxiety disorder sufferers should avail themselves of all the remedies available–including the spiritual remedies–but he or she should always be sure to speak to a mental health professional for treatment.
Which professionals should I turn to?
Many professionals treat depression, including General Practitioners, Psychiatrists, Psychologists, Clinical Social Workers, and Mental Health Counselors. People are often confused about who can help best with their anxiety. The following can help you decide where to start.
General Practitioners–General Practioners/Family Doctors are often the first responders to anxiety disorders. While your family doctor can be a first stop on your road to recovery, he or she should not usually be the person primarily responsible for treating your anxiety because they simply don’t have all the tools and training necessary to offer you the fullest array of treatment options.
Psychiatrists are medical doctors who use medication almost exclusively to treat mental health problems. Psychiatrists, as a general rule do not do psychotherapy, nor do most have training in psychotherapy but they do refer patients to therapists. After an initial consultation, most appointments with a psychiatrist consist of monthly medication checks to assess the effectiveness of what’s been prescribed and make any necessary adjustments to prescriptions.
Psychologists are Ph.D-level clinicians with state licenses to offer counseling and psychotherapy. Generally speaking, they do not prescribe but refer to physicians when medication is necessary. While many other professionals provide psychotherapy to clients, psychologists are particularly known for their training in psychological testing and evaluation.
Clinical Social Workers, Mental Health Counselors, Marriage & Family Therapists–May be either Ph.D. or master’s level clinicians with state licenses to offer counseling and psychotherapy. They do not prescribe medication but will refer to physicians if medication is necessary. Each of these professionals may have slightly different specializations but for the most part, all are qualified to treat anxiety and related disorders.
Many Catholics wonder if they should seek Christian counseling/counselors for help. The answer is, “it depends.”
While research shows that clients are generally more satisfied and treatment progresses more rapidly when the mental health professional and client share values, clients should be aware that many “Christian counselors” have no training or license to do psychotherapy, but merely give “biblically-based” advice of one sort or another. In fact, many so-called Christian Counselors are hostile to psychotherapy and psychology in general.
That said, Pastoral Counselors are a type of Christian counselor who are licensed professionals and, in additional to their clinical training, have degrees or other specialized training in theology. Ideally, a Catholic person suffering with anxiety might benefit most from counseling with a Catholic Pastoral Counselor, a licensed mental health professional who was also trained in Catholic theology/spirituality, but these can be difficult to find (see Resources for options).
The bottom line is, when seeking treatment for anxiety, identify the most competent professionals you can find. From that short list, choose the one you believe will be most supportive of your faith and values.
Peace Be with You!
If you or something you love is dealing with an anxiety disorder, get help today. God has great plans for your life. Bl. Pope John Paul II was fond of reminding us to “become what you are.” You are God’s child. You are loved. You are precious in his eyes. Don’t let anything, not even your own feelings, stand in the way of experiencing how much God cherishes you and wants to bless you with his healing, peace, and all the qualities that enable you to live life as a gift.
God Help Me! This Stress is Driving Me Crazy! (Dr. Gregory Popcak)– offers practical techniques and insights from our Catholic faith for dealing more effectively with stress and the emotional struggles that result.
When Panic Attacks (David Burns)–A secular book that represents the gold standard for treating anxiety. Extremely practical & research-based. A great complement to treatment.
If you or someone in your family has experienced any of the challenges described in this article, or would like to speak to someone about the possibililty of seeking professional help from a counselor, contact your PaxCare Tele-Coach. We can help you find faithful solutions to any of the above stress or anxiety-related issues. Call us to get the support you need to succeed.