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1. Normal Anxiety
vs.
Anxiety Disorders

4. Knowing the Difference
 How do I know what I am dealing
with?
 What are the Signs of Normal
Stress?
 What are the Symptoms of a Mental
Illness?
 Should I get treatment?
 What will people think of me

5. “It’s what you learn
after you know it all
that counts”
Harry Truman

6. Generally speaking….
If anxiety is affecting you or someone
you know, it's important to learn
the difference. In general, anxiety is a
normal reaction to stress. In fact, it
can be a good thing. ... An anxiety
disorder, however, involves intense
and excessive anxiety, along with
other debilitating symptoms.

7. ANXIETY
 Everyone will experience anxiety from time to time.
The demands and stress of life may even make
experiencing anxiety more frequent.
 Anxiety is a normal reaction to stress. In fact, it can
be a good thing. Anxiety motivates you to
accomplish things, try harder, and it can warn you
when you’re in a dangerous situation. It informs you
to be extra vigilant about your environment.
 Is usually the response to a stressor: such as job
stress, family or financial problems, conflict in
relationships, tests, speaking assignments,
excessive responsibilities, etc.

8. The Disorder
 An anxiety disorder, however, involves
intense and excessive anxiety, along
with other debilitating symptoms.
 Anxious all the time
 Can’t necessarily spot a reason
 Can’t hardly make it through the day
 Small things are overwhelming
 Intense and excessive emotional
feelings

9. General Differences
A person without a disorder might be
anxious right before an exam.
Their anxiety is fleeting and short lived.
A person with Generalized Anxiety
Disorder might feel anxious weeks
before the exam.
This person’s anxiety is ongoing and
lasts for weeks or even months.

10. NORMAL STRESS / ANXIETY
 Is related to a specific situation or
problem
 Lasts only as long as the situation or
problem
 Is proportional to the situation or
problem
 Is a realistic response to a realistic
problem or situation

13. BURNOUT
 Can be debilitating
 Usually results in job/role dissatisfaction
 Can mimic or trigger an anxiety or mood
disorder
 Mostly need attention to self-regulation
 May need professional intervention if not
resolving within a few weeks.

14. ANXIETY DISORDER
 Comes up unexpectedly, for seemingly no reason
 The anxiety response to a situation or problem may
be much stronger that they would expect
 They may experience a lot of unrealistic anxiety,
such as fear of a situation that likely will never
happen
 Lasts a long time, even when the situation or
problem has been resolved
 Feels impossible to control or manage
 Avoids situations or things that they believe to
trigger anxiety symptoms

15. ANXIETY SYMPTOMS
 Persistent worrying or obsession about small
or large concerns that's out of proportion to
the impact of the event
 Inability to set aside or let go of a worry
 Inability to relax, restlessness, and feeling
keyed up or on edge
 Difficulty concentrating, or the feeling that
your mind "goes blank"
 Worrying about excessively worrying

16. ANXIETY – EVEN MORE
 Distress about making decisions for fear of
making the wrong decision
 Carrying every option in a situation all the
way out to its possible negative conclusion
 Difficulty handling uncertainty or
indecisiveness
 Physical signs and symptoms

17. Anxiety Disorder - Physical Symptoms
 Dizziness
 Light-headedness
 Sweating
 Trembling
 Heart pounding
 Headache
 Nausea
 Muscle tension or muscle aches
 Feeling twitchy
 Being easily startled
 Trouble sleeping / FATIGUE
 Diarrhea or irritable bowel syndrome

18. TYPES OF ANXIETY DISORDERS
 Generalized anxiety disorder
 Social anxiety disorder
 Panic disorder
 Post-traumatic stress disorder
 Obsessive compulsive disorder
 Phobias

19. A person with GAD might say:
“You feel like you can’t breathe, can’t talk
or have to go to the bathroom frequently.
You feel detached or disconnected from
reality. At times you can’t think straight
and have difficulty concentrating. I have
racing or negative thoughts, and am
unable to concentrate and worry about
day-to-day things. “

20. They might also say:
“When I struggle with anxiety, it affects my
entire life. It impairs or interferes with my
schoolwork, job and daily life. I want to avoid
every one and every thing. It can be quite
debilitating. I want to avoid normal activities. I
want to skip class, miss a test, stop going to
work, procrastinate grocery shopping or avoid
anything that makes me feel anxious.”

21. Grief and Sadness
vs.
Depression

23. DEPRESSION (Illness?)
 Depression is a medical condition that
can affect a person’s ability to work,
study, interact with people or take
care of themselves.
 Everyone feels grief, sadness, or
alone at some point. Normal grief is
situational and typically resolves.

24. DEPRESSION
 When sadness becomes too much to
handle, or lingers for a long time, it
may be a sign of depression.
 It can be caused by imbalances in
brain chemistry. But it can also be
triggered by stress, poor nutrition,
physical illness, personal loss, and
school or relationship difficulties.

25. DEPRESSION
 Not everyone experiences depression in the same
way. Depressed people may appear withdrawn and
despondent, or they may be aggressive and self-
destructive. Some people may be depressed about
a specific problem, while others feel deeply unhappy
without knowing why. Sometimes, a depressed
person may even appear “fine” to their friends and
family. The common thread, however, is an
overwhelming, persistent feeling of despair.

26. DEPRESSION
 Persistently sad, anxious, irritable or empty
mood
 Loss of interest in previously enjoyable
activities
 Withdrawal from friends and family
 Trouble sleeping or sleeping too much
 Fatigue and decreased energy
 Significant change in appetite and/or weight
 Overreaction to criticisms

27. DEPRESSION
 Feeling unable to meet expectations
 Difficulty concentrating, remembering details, and
making decisions
 Feelings of worthlessness, hopelessness or guilt
 Persistent physical symptoms such as headaches,
digestive problems or chronic pain that do not
respond to routine treatment
 Substance abuse problems
 Thoughts of suicide or suicide attempts

28. Where does all this
come from?

29. THE BRAIN

30. THE SCIENCE
 Mood and Anxiety Disorders are
characterized by a variety of neuroendocrine,
neurotransmitter, and neuroanatomical
disruptions.
 Complicated by the high degree of
interconnectivity between circuits in the limbic
system, brain stem, and higher cortical brain
areas.

31. NEURON ACTIVITY

32. THE SCIENCE
 Symptoms of mood and anxiety disorders are
a result in part from disruption in the balance
of activity in the emotional centers of the
brain rather than the higher cognitive centers.
 Explains why we can’t “think ourselves
better”.
 Genetic studies have focused on the activity
of the hypothalamus – pituitary – adrenal axis
(HPA).

34. CORTEX
 Executive Functioning such as planning,
decision-making, predicting consequences
for potential behaviors, understanding and
modifying social behaviors.
 Orbitofrontal cortex codes information,
controls impulses, and coordinates mood with
Limbic system.
 Ventromedial cortex is involved in reward
processing and regulating our response to
emotions.

36. LIMBIC SYSTEM
 Well-documented research shows a
significant relationship with neurotransmitters
in this area (Serotonin, Norepinephrine, &
Dopamine) and mood disorders.
 PET scans show increased glucose activity
and changes blood flow in this area,
especially during panic attacks.

38. LIMBIC SYSTEM
 Amygdala: responsible for emotions, survival
instincts, labido and memory
 Hippocampus: responsible for emotional
regulation and long term memory
 Thalamus: is involved in sensory and motor
signal relay and the regulation of
consciousness and sleep

40. LIMBIC SYSTEM
 Hypothalamus: links the nervous and endocrine
systems by way of the pituitary gland. Its function is
to secrete releasing hormones
and inhibiting hormones that stimulate or inhibit.
Responsible for Homeostasis (bringing balance or to
a set point like a thermostat). Hunger, thirst,
response to pain, levels of pleasure, sexual
satisfaction, anger and aggression, and Autonomic
Nervous System regulation (BP, pulse, breathing,
disgestion, etc.).

42. Example of Malfunction
 It is hypothesized that symptoms of PTSD,
including intrusive thoughts and re-
experiencing trauma, result from an inability
of higher cognitive structures to repress
negative emotional memories. This task
requires interrelated executive and emotional
processing systems. Sensory deficits result
from systems being overpowered by
hypervigilance and hyperarousal.

43. NEUROTRANSMITTERS:
Limbic system over-activity in patients
with Generalized Anxiety is from:
 Decreased inhibitory
neurotransmitters
 Increased excitatory
neurotransmitters
 Or a combination of both

44. WOW
 The Brain is so complicated
 There is so much more:
Glutamate and GABA
 Complicated to understand and explain the
pathology and etiology of Mental Illness
 Even harder to have an exact science with
medications
 Medications and Learning is important

45. THE EMOTIONAL TRIAD
ANGER
FEAR
PAIN

46. PAIN - CAUSED BY 4 THINGS
LOSS
REJECTION
FAILURE
PHYSICAL

47. ANXIETY – WARNING OF PAIN
 Anxiety is the emotion that warns us
of an impending hurt or danger
 Anxiety can motivate or paralyze
 Warning sign to fight or flee
 Never pleasant
 Designed to protect us

48. ANGER –
OUR DEFENSE MECHANISM
 RAGE
 DEFENSIVENESS
 SILENCE
 SARCASM
 JEALOUSY
 CRITICAL / IRRITABILITY
 RESENTMENTS

49. TREATMENT FOR ANXIETY
AND DEPRESSION
 We can talk about them together or separate
due to the nature of the illness and the similar
pharmaceutical approaches.
 Many people have both.
 Treatment can be compartmentalized if
necessary based on the diagnosis.
 Cognitive Therapy + Medication = greatest
success.

50. TREATMENT (cont)
 Primary Treatment Issue – RISK / SAFETY
 Crisis Resources
 Assess Resources – determines options
 Patient Centered
 Rx: SSRI’s/SNRI’s/Lithium/Tricyclics/others
 Therapy
 Education
 Stress Management Skills
 ECT for refractory depression / bipolar

51. RECOVERY
THERE IS HOPE
TREATMENT WORKS
MANY DO RECOVER
QUALITY OF LIFE WITH
ONGOING TREATMENT