Therapy for Anxiety and Panic Disorders

Many times when a client experiences anxiety, he or she may not believe that they are suffering from an anxiety disorder. The common conception of anxiety is that it gives him or her the extra drive he or she needs to get the job done. However, there is a great deal of difference between normal anxiety and abnormal anxiety, would you agree?

In this section, we will examine the three basic manifestations of anxiety, which are adaptive anxiety, unadaptive anxiety, and agoraphobia. 

Understanding the Three Manifestations of Anxiety

♦ Manifestation #1 - Adaptive Anxiety
First, we will discuss normal or adaptive anxiety. Normal anxiety is an anxiety response to stimulus situations objectively associated with danger. This type of anxiety is known to be adaptive. This type of anxiety actually helps a client who needs the extra push to complete a task or make a decision that would otherwise have been left undone. Also, clients who experience anxiety before a surgery are less likely to experience postoperative depression.

Normal anxiety can be a useful tool in aiding a client throughout stressful periods. Because anxiety is an associated feature of many other psychiatric disorders, it becomes difficult to discern whether the acute anxiety that the client feels is the disorder itself or an associated feature of another disorder. 

Also, the symptoms of anxiety may be confused with physical illnesses. For example, how many times have you heard of a patient rushing into the emergency room for a heart attack and it was found out that they were only having an anxiety attack? 

♦ Manifestation #2 - Unadaptive Anxiety
Unadaptive or abnormal anxiety arises from no specific cause or danger. This type of anxiety is much more severe, intense, and pervasive than adaptive anxiety. In essence, when the level of anxiety is considerable, it begins to affect and impair other behaviors as well. Muscle tension impairs motor skills; mental concentration is often inhibited; and social functioning may also be impeded.

To determine adaptive from unadaptive anxiety, many physicians use three factors: if the severity of the anxiety bears little relationship to the situation, if the anxiety interferes with the capacity to experience satisfaction or pleasure, and if the anxiety restricts normal activity. 

Peggy was a 53 year old client of mine. Her entire life, she had been generally known as "high-strung" and "nervous." Peggy tended to have trouble relaxing, was often restless, and felt shaky inside. She worried a lot, particularly about her children, finances, and about how others saw her.  Peggy usually always felt better if she was active and busy. Peggy stated, "If I sit down, all my fear catches up with me, and I hate that feeling. I’d rather be productive than be overwhelmed by my worry." 

However, as the day began to wind down, it seemed harder to avoid her problems and keep her feelings in check. As a result, Peggy had trouble falling asleep at times. She knew that when she was tense and under stress, the muscles of her neck contracted, and she had terrible headaches.  Not only that, but Peggy was also prone to gastrointestinal ailments, such as indigestion, nausea, and diarrhea. 

When feeling overwhelmed, Peggy’s physical and emotional symptoms escalated and she experienced vague feelings that something terrible was going to happen. Frustrated and alone, Peggy feared going crazy or losing control. As you can see, Peggy’s anxiety had reached such a pitch that she could no longer feel satisfaction in her life. Obviously, Peggy was suffering from unadaptive anxiety that began to inhibit the other aspects of her life.

♦ Technique:  Sit, Don’t Run
Peggy used activity to keep her mind off of her other many worries. By doing this, however, she was merely avoiding her anxiety and not addressing it. To help Peggy move beyond merely occupying herself and actually cope with these overwhelming feelings of panic, I suggested she try the "Sit, Don’t Run" technique. I asked Peggy to complete the following steps when she felt her unfounded anxiety creeping up on her and she greatly desired to divert herself with activity:

After completing this exercise, Peggy stated, "Incredibly, I don’t feel that feeling as much anymore. Well, it still comes and goes, but I don’t have to be doing anything to avoid it. I can just sit down and accept it." As you can see, by allowing herself to feel the panic and not let it control her, Peggy could more effectively begin to address her anxiety.

♦ Manifestation #3 - Agoraphobia
In addition to adaptive and unadaptive anxiety, the third type of disorder stemming from anxiety is agoraphobia. Agoraphobia, as you are aware, is the fear of having a panic attack in certain places where there would be no help. Agoraphobia can quickly lead into fear of certain public places, closed in areas, animals, or people that the agoraphobic client associates with panic attacks. 

Stewart was an agoraphobic client of mine who had developed a fear of a certain busy street on which he had had a panic attack. During this panic attack, Stewart had severe hyperventilation, dizziness, and chest pain. Even though the street had been full of people, no one had helped him.  Finally, Stewart had been able to find his way back home, despite the overpowering symptoms. 

Because of this incident, Stewart had developed a fear of that specific street and had maintained this fear for several years.  We will discuss agoraphobia and techniques for treating it more thoroughly in another section.

In this section, we discussed the three basic manifestations of anxiety, which were adaptive anxiety, unadaptive anxiety, and agoraphobia. 

In the next section, we will examine three gradations of anxiety intensity, which are spontaneous anxiety; situational anxiety; and anticipatory anxiety.

- Robin, M., Ph.D, & Balter, R., Ph.D. (1995). Performance Anxiety: Overcoming your Fear in the Workplace, Social Situations, Interpersonal Communications, and the Performing Arts. Holbrook, MA: Adams Media Corporation.
Reviewed 2023

Peer-Reviewed Journal Article References:
Levinson, C. A., Zerwas, S., Calebs, B., Forbush, K., Kordy, H., Watson, H., Hofmeier, S., Levine, M., Crosby, R. D., Peat, C., Runfola, C. D., Zimmer, B., Moesner, M., Marcus, M. D., & Bulik, C. M. (2017). The core symptoms of bulimia nervosa, anxiety, and depression: A network analysis. Journal of Abnormal Psychology, 126(3), 340–354.

Niileksela, C. R., Ghosh, A., & Janis, R. A. (2020). Dynamic changes in generalized anxiety and depression during counseling.Journal of Counseling Psychology. Advance online publication.

Probst, T., Berger, T., Meyer, B., Späth, C., Schröder, J., Hohagen, F., Moritz, S., & Klein, J. P. (2020). Social phobia moderates the outcome in the EVIDENT study: A randomized controlled trial on an Internet-based psychological intervention for mild to moderate depressive symptoms. Journal of Consulting and Clinical Psychology, 88(1), 82–89.

Rogers, A. H., Gallagher, M. W., Garey, L., Ditre, J. W., Williams, M. W., & Zvolensky, M. J. (2020). Pain Anxiety Symptoms Scale–20: An empirical evaluation of measurement invariance across race/ethnicity, sex, and pain. Psychological Assessment. Advance online publication. 

Roos, C. R., Bowen, S., & Witkiewitz, K. (2017). Baseline patterns of substance use disorder severity and depression and anxiety symptoms moderate the efficacy of mindfulness-based relapse prevention. Journal of Consulting and Clinical Psychology, 85(11), 1041–1051.

QUESTION 1
What are three basic manifestations of anxiety? To select and enter your answer go to Test.