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galley Anxiety Mentall Illness

Mental Illnesses and Disorders Awareness and Understanding

a n x i e t y d i s o r d e r s

Mental Illnessesand Disorders

Alzheimer’s Disease Anxiety Disorders Attention-Deficit Hyperactivity Disorder Autism SpectrumDisorders Bipolar Disorder Depression

Disruptive Behavior Disorders Drug andAlcohol Dependence Eating Disorders Obsessive-Compulsive Disorder Post-Traumatic Stress Disorder Schizophrenia Sleep Disorders

Mental Illnesses and Disorders Awareness and Understanding

Disorders Series Consultant Anne s. Walters, PhD Chief Psychologist, Emma Pendleton Bradley Hospital Clinical Associate Professor, Alpert Medical School/Brown University Anxiety H.W. Poole

Mason Crest

Table of contents

Introduction to the Series . . . . . . . . . . 7 Chapter One: Nervous Is Normal . . . . . . . . 9 Chapter Two: When Anxiety Becomes a Problem . 16 Chapter Three: Diagnosing Anxiety Disorders . . . 29 Chapter Four: Treating Anxiety Disorders . . . . 35 Further Reading . . . . . . . . . . . . . 44 Series Glossary . . . . . . . . . . . . . . 45 Index . . . . . . . . . . . . . . . . . 47 About the Authors . . . . . . . . . . . . . 48 Photo Credits . . . . . . . . . . . . . . 48

Key Icons to Look for:

Words to Understand: These words with their easy-to-understand definitions will increase the reader’s understanding of the text, while building vocabulary skills.

Sidebars: This boxed material within the main text allows readers to build knowledge, gain insights, explore possibilities, and broaden their perspectives by weaving together additional information to provide realistic and holistic perspectives. Research Projects: Readers are pointed toward areas of further inquiry connected to each chapter. Suggestions are provided for projects that encourage deeper research and analysis. Text-Dependent Questions: These questions send the reader back to the text for more careful attention to the evidence presented there.

Series Glossary of Key Terms: This back-of-the-book glossary contains terminology used throughout the series. Words found here increase the reader’s ability to read and comprehend higher-level books and articles in this field.

Introduction to the Series TK

Chapter One

N e r v o u s i s N o r m a l

Words to Understand anxiety: a feeling of worry or nervousness. panic attack: sudden and overwhelming fear, with no real danger present. physiological: relating to the function of the body. response: a reaction to something. trigger: something that causes something else to happen.

Have you ever felt nervous? Maybe you . . .

• overslept one morning and had to rush through breakfast. You might have felt nervous that you’d miss your bus and get in trouble. • had trouble sleeping because you kept thinking about your team’s important game the next day. You might have worried about playing well. • had to speak in front of your whole class. The thought of everyone looking at you might have made you very nervous. • overheard your parents arguing. The sound of their angry voices might have made you worried, even if they weren’t yelling right at you.

It’s common to have trouble sleeping if you are feeling anxious about something.

Fight or Flight

Have you ever watched a pet react to a threat—another animal, a passing car, or even a vacuum cleaner? You might see the pet’s body get tense, its ears and tail standing at attention. It might become very excited, pacing around and making noise. This is what is known as the fight-or-flight response . Animals (and that includes us humans) have physiological responses to fear. Our hearts beat faster, we breathe faster, and

blood flow increases. The body is getting ready to face a threat. We might “fight” the threat or we might “flee” it, depending on our personalities and the nature of the threat. But the response—that racing of the heart and tensing of the body—is an ancient safety technique. Like nervousness, the fight-or-flight response is completely normal. But sometimes people have the same feelings when there is no threat. This is when anxiety can become a problem.

These feelings are anxiety . They are all completely normal. Anxiety is just a form of fear, and fear is nothing to be ashamed of. There is nothing more normal for humans than anxiety. Anxiety Isn’t All Bad The ability to feel nervous can be a good thing. Our ancient ancestors were afraid of large animals like bears and lions, and for good reason! After all, the caveman who feared lions lived long enough to have children. But the caveman who felt no

? Did You Know? About 25 percent of all teenagers struggle with anxiety at some point. More than 5 percent of teenagers have severe anxiety.

fear of lions often did not live very long at all. Today, a fear of fire or a fear of crossing busy streets can keep you safe in just the same way. Anxiety can do more than just save lives. We now know that a little anxiety sparks extra brain activity. Being a bit nervous about a test is actually a good thing: studies have found that a little anxiety can help your memory. Many skilled performers still feel nervous before they step out on stage. That little jolt of anxiety can create a better performance. However, when it comes to anxiety, there can be too much of a good thing. Large amounts of anxiety actually cause less brain activity. That’s probably why people talk about being so nervous that they “freeze up” and “can’t think.” Scientists believe that a little anxiety speeds the brain up, but a lot of anxiety slows the brain down. Too Much Anxiety? Feeling anxious is part of being human. If you are going through a difficult time in your life—if your mother or father just lost a job, for example, or if you are moving to a new town—you might feel anxious a lot. And that’s okay. When the difficult time passes, you will feel better. But sometimes, people don’t feel better. Sometimes the feelings of anxiety are so strong that they can’t do what they want to do. Some people become so nervous that they begin to sweat and shake, have trouble breathing, and feel sick. These experiences are called panic attacks , and they can be very frightening.

Opposite page: If life is stressful in your home, it’s natural that you might feel anxious.

If these feelings are so strong that they run your life, you may have an anxiety disorder. Sometimes people with anxiety disorders feel nervous because of a particular situation, like a test or a class presentation, but many times there is no specific cause at all. There is no test, no class presentation. They just feel anxious anyway. It seems like the fear is in charge, rather than the person. Anxiety disorders are very common. In fact, anxiety disorders are the most common mental disorder in North

Giving a presentation is enough to make anyone nervous.

America. They can be very scary and frustrating for people who have them. They can also be frustrating for their friends and families. But anxiety can be overcome. With help, you can learn what triggers your anxiety. You can also learn what to do when those feelings occur. Some people need to take medication to control the feelings. Sometimes it is possible to learn to control the feelings in other ways. Sometimes both might be needed. It all depends on the type of anxiety disorder and how bad it is. Anxiety disorders and how to handle them should always be discussed with your doctor. The most important thing to remember is that lots of people have anxiety disorders. And lots of people learn to manage that anxiety and have great lives.

Text-Dependent Questions 1. Why was being fearful sometimes good for our ancestors?

2. Describe a situation when feeling nervous or anxious actually helped you. What made you nervous, and how did that feeling end up being useful? 3. Describe a situation when feeling nervous or anxious was a problem for you. What caused the feelings, and what did you do to handle them? Research Project Interview friends, family members, and teachers to find out what makes them feel anxious, and also what they do to feel better. Turn their answers into a list of ideas for what you can do the next time you feel anxious. Try out the ones that sound good to you.

Chapter Two

W h e n A n x i e t y B e c o m e s a P r o b l e m

Words to Understand chronic: lasting a long time or happening often. compulsion: feeling that a particular act is absolutely necessary no matter what. obsession: thoughts, impulses, or images that will not go away. symptom: a physical or mental sign that a person may have an illness. trauma: an event that causes extreme mental or physical stress.

It’s natural to feel anxious sometimes. But when anxiety keeps you from doing things you want to do, it can be a problem. This chapter talks about the different types of anxiety disorders. These types are defined by the cause of the anxiety and by the symptoms . Later chapters will discuss how these disorders are treated. But remember, only your doctor can say for sure if you have one of these disorders.

Generalized Anxiety Disorder Doctors define generalized anxiety disorder (GAD) as

It’s common to have trouble sleeping if you are feeling anxious about something.

• feeling strong anxiety, • on most days, • for at least six months, • with no specific cause.

Symptoms of GAD

People with GAD tend to:

• worry a lot about everyday things • have trouble controlling their worry • worry about worrying too much • have a hard time relaxing • have a hard time concentrating • be easily startled • feel tired a lot but have trouble sleeping

• have headaches, stomachaches, or unexplained pain • have trouble swallowing • tremble or twitch • feel irritable • sweat a lot or feel light-headed • go to the bathroom a lot

Having one or even a few of these symptoms does not mean a person definitely has an anxiety disorder. But these symptoms could be a sign of a problem.

Having GAD can feel a lot like how you feel before taking a test. The difference is that after the test is over, you feel better. With GAD, there is no test, and the feeling doesn’t go away.

People with GAD have trouble controlling their chronic worry. Their worry keeps them from leading a regular life. They may feel restless or grouchy. They may have trouble sleeping. Many people with GAD also have physical symptoms, such as stomachaches, backaches, and headaches. People with GAD might have panic attacks, which makes them feel sweaty, nauseous, or shaky.

Did You Know?

Anxiety disorders affect about 18 percent of the population of the United States.

People with GAD often feel embarrassed about their anxiety. This just makes the anxiety even worse. Some people with GAD have felt anxious their whole lives. Other times, GAD develops over time. Many people with GAD come from families in which anxiety is common. Specific Phobias A person with a phobia has many of the same symptoms as a person with GAD—with one big difference. People with GAD worry about all kinds of things. People with a phobia fear one specific thing. For example, a person with arachnophobia will panic at the sight of spiders. A person with claustrophobia

Lots of people might think this jumping spider is pretty creepy, but that’s not a phobia. A fear of spiders has to be very intense

to be considered arachnophobia.

Unique Phobias

You have probably heard of people who have an unreasonable fear of snakes (ophidiophobia) or of airplanes (pteromerhanophobia). These are very common phobias. But some phobias might seem strange to you, such as:

• botanophobia: fear of plants • cacophobia: fear of ugliness • leukophobia: fear of the color white • papyrophobia: fear of paper • podophobia: fear of feet • selenophobia: fear of the moon • wiccaphobia: fear of witches

The full moon—beautiful or scary? Depends on whether or not you have selenophobia.

These phobias might seem strange. But remember, even a phobia that seems weird to you is still terrifying for the person who has it.

fears small spaces, and he or she may have a panic attack if forced to use an elevator. Feeling anxious about a certain situation does not necessarily mean you have a phobia. It is common for young kids to get anxious during thunderstorms, but that does not mean they have astraphobia (fear of thunder). And nobody likes getting a shot at the doctor’s office, but that does not mean we all have trypanophobia (fear of needles). When someone has a phobia, the feelings are much stronger than what most people experience, and those feelings can interfere with everyday life.

Some phobias are linked to childhood events. A good example is cynophobia , which means intense fear of dogs. Many people with cynophobia had a very bad encounter with a dog when they were young. That frightening moment causes them to intensely fear all dogs. Other times, there is no clear reason why people have particular phobias. They just do. Social Anxiety Social anxiety is the intense fear of what doctors call a “performance situation.” A performance situation could be as important as a big game or test. It could also be as minor as saying hello to a stranger.

Obsessive-Compulsive Disorder

A person with obsessive-compulsive disorder (OCD) feels he or she must complete certain actions or something terrible will happen. Common obsessions and compulsions include hand washing, counting things or putting them in a certain order, checking to make sure something has been done, or

repeating specific words or phrases over and over. Because having OCD usually involves feeling anxious a lot, OCD used to be called an anxiety disorder. However, doctors now believe that OCD is a separate condition. For a longer talk about OCD, please refer to another book in this set, Obsessive- Compulsive Disorder.

People with social anxiety have a lot of trouble talking to people they don’t know well. Unfortunately, this can make others think that the person is unfriendly or stupid, which only makes the person with the anxiety feel worse. Having social anxiety is kind of like having a phobia. In fact, doctors used to refer to social anxiety as “social phobia,” and you still might hear that term sometimes.

People with social anxiety disorder

often worry that they are being judged by others, even when it isn’t true.

People with social anxiety panic at the thought of being embarrassed in public. They tend to have very few friends. This is not because they don’t want friends. They do! But their fear holds them back. If you have social anxiety, you are not alone. The

? Did You Know? About 25 percent of teenagers struggle with anxiety at some point. More than 5 percent of teenagers have severe anxiety.

disorder affects about 15 million Americans every year. It usually begins when people are teenagers, although it can start at any time.

Panic Disorder We have talked about how people with GAD or with phobias sometimes have panic attacks. Panic attacks are a symptom of their anxiety. But some people have panic disorder, which means they have lots of panic attacks. And they often worry about when they might have another. People with

For people with social anxiety disorder, the simple act of talking to other kids can feel impossible.

Skipping School

Have you ever woken up in the morning and wished you didn’t have to go to school? Of course you have, because everyone feels that way sometimes. Adults feel that way about going to work sometimes, too. But we go to

school or work anyway, and most of the time, the bad feelings pass once we get there. Some kids with anxiety disorders feel so worried and upset that they refuse to go to school at all. It is understandable that they feel this way, but skipping school is a big problem. These kids don’t just miss their lessons, they also miss out on seeing their friends. Making friends is a huge part of growing up. If your feelings of anxiety are keeping you from school, it’s very important to talk to an adult you trust. You might not believe this, but things can get better.

panic disorder tend to avoid places where they have had panic attacks in the past. People with panic disorder often think their attacks are symptoms of some other terrible disease. They may even think that they are dying or “going crazy.” Sometimes even doctors can’t convince them that they are healthy. The definition of a panic attack is a period of intense fear or discomfort, during which specific symptoms happen very quickly, and peak within 10 minutes. These symptoms include: • heart palpitations (a feeling of fluttering in the heart) • sped-up heart rate • sweating

• trembling or shaking • shortness of breath

• feeling of choking or smothering • chest pain • nausea/upset stomach • feeling dizzy or light-headed

• derealization (feeling like the world has become unreal) • depersonalization (feeling detached from yourself)

• fear of losing control • fear of being “crazy” • numbness or tingling feeling • chills or hot flashes

About 1.7 percent of teens and adults are diagnosed with agoraphobia each year.

A panic attack doesn’t usually involve all these symptoms at once. If at least four of them are present, then the episode is probably a panic attack.

Some panic disorders go hand-in-hand with another disorder, called agoraphobia . In ancient Greece, the agora was a large, open area where people gathered. So, agoraphobia is the fear of open or public places. Because people with panic disorder fear having an attack, they sometimes stay inside more and more. About a third of the people with panic disorder develop agoraphobia and become afraid to leave their homes. Post-Traumatic Stress Disorder So far, we’ve talked about anxieties people have when there is nothing to be afraid of. But our last kind of anxiety disorder is quite different. The fears of people with post-traumatic stress disorder (PTSD) are very real. During World War I (1914–1918), doctors noticed that some soldiers suffered from what they called “shell shock.” It

Veterans of World War I, like these wounded Belgian soldiers, were found to have an

illness called “battle fatigue.” We now call this PTSD.

PTSD in Daily Life

Unfortunately, lots of kids have PTSD. Sometimes the traumatic event is something very dramatic, like a school shooting or a tornado. But PTSD can also come from something very average, like a car accident. Violence in a home or neighborhood can also cause PTSD. Any event where a child feels his life is in danger is a potential trigger.

was not until after the Vietnam War (1954–1975), however, that doctors created a special definition for this type of anxiety. These days, PTSD can be found in anyone who has survived a trauma. Abused children sometimes have PTSD. So do people who lived through a sexual assault, a robbery, or a natural disaster like a hurricane. People with PTSD have feelings of intense fear, helplessness, and horror. They have repeating thoughts and dreams about the trauma. Sometimes they even have flashbacks, in which they believe the traumatic event is happening again. Recently, doctors have begun discussing a new type of the disorder, called complex PTSD (C-PTSD). This type is caused by repeated trauma, experienced over and over again for a long time. For example, being abused for many years might cause C-PTSD. Growing up in a high-crime neighborhood can also cause it. People with C-PTSD never know when the next bad thing is coming, so they tend to be constantly

“on guard.” They often have trouble trusting others, and sometimes they have difficulty controlling their anger. For more information on PTSD, please refer to another book in this set, Post-Traumatic Stress Disorder.

Text-Dependent Questions 1. What are some of the differences between regular worry and a disorder? 2. What are some of the symptoms of a panic attack? 3. Why might a person who survived a robbery have the same symptoms as a war veteran? Research Project Choose one of the anxiety disorders in this chapter and find out what resources exist to help people who have it. For example, you might check the website of the Anxiety and Depression Association of America, the National Institute of Mental Health, or the National Center for PTSD. Make a list of what you think are the most helpful resources.

Chapter Three

D i a g n o s i n g A n x i e t y D i s o r d e r s

Words to Understand diagnose: examine a patient to discover what condition or disorder he or she has. psychotherapy: treatment of mental problems through talking with a professional.

Doctors can treat anxiety disorders with medicine or psychotherapy , or a combination of both.

Getting Help What should you do if you feel that your worrying is out of control? The first step is to talk to a parent or other adult you trust. You will probably need to visit a doctor. Your regular pediatrician is a good place to start. After that, you might visit a therapist or someone who specializes in anxiety disorders.

If you hurt your arm, you would go see a doctor for help. Getting help for mental problems is really no different.

When you are sick, a doctor will examine your body to figure out what is wrong. The same goes for anxiety disorders— it’s just that the tests might be different.

Talking to a doctor about anxiety might feel weird or even scary. But it is just like talking to your doctor about any other problem. If you have a stomachache, your doctor might ask questions about where exactly it hurts. She might ask if you feel a sharp pain or a dull ache. This is because different illnesses can cause different types of stomachaches. She might ask what you ate the night before, because stomachaches caused by bad food are different from other types. Through these questions, the doctor will

Did You Know? In almost all situations, doctors will talk to you without your parent in the room. It is okay to ask for privacy if you need it.

begin to diagnose your problem. This will help the doctor figure out how to fix it. That’s why it is very important to tell your doctor the truth. Some of the doctor’s questions might be embarrassing. For example, consider the stomachache again. You might not want to admit that you ate a bag of candy the night before. But that information is important. The doctor needs to know about the candy, or her diagnosis will be wrong. Everything said above about stomachaches is true for mental disorders, too. Finding the Cause Before a doctor diagnoses a mental disorder, other problems must be ruled out. For example, a breathing problem called asthma can cause symptoms that might feel similar to anxiety. So can heart problems. In fact, there are many physical problems that can look and feel like anxiety. Even too much coffee or soda can make people jumpy. Your doctor probably will check for these problems first. If you are healthy in all other ways, it will be time to talk about mental causes of anxiety. Your doctor will ask questions like: • How often do you feel anxious? • What does it feel like in your body when you are anxious? • Does a specific event or place make you feel more anxious? • Is there anything you do to help the feelings go away?

Opposite page: A mental health professional asks

questions to try and figure out the cause of a patient’s anxiety.

The doctor is not trying to be nosy. He needs this information to understand what type of anxiety you have.

Different problems need different solutions. These questions help the doctor figure out the right solutions for you. It might be hard, but you must tell the truth. For example, it might be embarrassing to say, “I count from 1 to 12 in my head. If I do it 12 times, I feel a bit better.” You might not want to admit that you count in your head. You might think it “sounds crazy” to say so. But you are not “crazy”! And your doctor will not judge you. Your doctor wants to help.

Text-Based Questions 1. What are some physical illnesses that can look or feel similar to anxiety disorders? 2. Why do doctors ask so many questions? 3. Why is it important to be honest with your doctor? Research Project There are lots of physical problems that also involve anxiety. For example, asthma is a problem with breathing, but people with asthma also experience a lot of anxiety. Other examples include anemia, insomnia, premenstrual syndrome, bipolar disorder, and eating disorders. Select a physical problem that interests you, and then find out more about how anxiety plays a role. (If you are interested in bipolar disorder, eating disorders, or sleep disorders, you might start by reading other volumes in this set.)

Chapter Four

T r e a t i n g A n x i e t y D i s o r d e r s

Words to Understand behavioral: having to do with what a person does. cognitive: having to do with thinking and the brain. exposure therapy: to be put in a particular situation, in order to help reduce anxiety about the situation. neuron: a special type of cell that transmits signals along nerves. pharmaceutical: having to do with drugs. psychological: having to do with the mind. side effects: physical effects of drugs that are not intended.

Why do some people have anxiety disorders and others do not? Scientists do not know for sure. A problem with chemicals in the brain may be one cause. This is why medicine can be so helpful. Treating disorders with medicine is called a pharmaceutical approach. But brain chemistry is just one cause. Anxiety can also come from inside ourselves, from our feelings and thoughts. It can also come from outside ourselves, from our families, friends, and specific events. In these cases, doctors may use a psychological approach. Patients may meet with a therapist to discuss their feelings. Or they might have a particular kind of therapy to help them learn new ways of handling their anxiety.

Anxiety medication can be prescribed by a mental health professional, and the prescription is filled at the pharmacy. Both doctors and pharmacists should be able to answer any questions you might have.

Sometimes a person with anxiety will be treated with just one approach. More often, though, doctors use a bit of both. Researchers are still exploring whether medication alone, therapy alone, or medicine and therapy together are best for treating anxiety. For many kids, the combination helps the most. Medicine for Anxiety Several types of drugs are used to treat anxiety disorders. The most popular type has a very long name: selective serotonin reuptake inhibitors (SSRIs). You might have heard of drug names like Prozac, Luvox, Paxil, and Zoloft. These are all SSRIs. How do SSRIs work? Your brain has billions of special cells called neurons . SSRIs work by helping all those neurons do their jobs better.

Suicidal Thoughts

Studies have found that SSRIs might cause an increase in suicidal thoughts in certain patients.

The vast majority of patients do not have this problem, but it can happen. So if you or someone you know is having suicidal thoughts, it is very important to tell an adult right away. In fact, you should tell someone about all the side effects you experience from SSRIs. When kids are involved, doctors usually have a conversation with caregivers about what side effects might occur. Hopefully, this will make it easier to talk to them about it.

A doctor will often start a patient on a low dose of an SSRI. Over time, the doctor will carefully increase the dose until the right level has been found. SSRIs can be very helpful to people with GAD—but they are not magic. It can take time for SSRIs to work. Often, kids start to feel better in a week or so, but it can take up to six weeks for the medication to be fully effective.

I’m Not Hyper, I’m Worried!

Lots of kids have ADHD, which is short for attention-deficit hyperactivity disorder. (You can read more about it in another book in this set.) It’s natural for kids with ADHD to feel anxious. But feeling anxious now and again does not mean you have a disorder. Sometimes it can be tricky to tell the

difference between ADHD and an anxiety disorder. Someone with an anxiety disorder might have trouble concentrating in school because his worries are so distracting. On the other hand, someone with ADHD might feel anxious because she knows that she’ll get in trouble for not concentrating in school. In the first example, the ADHD symptoms are a result of the anxiety disorder. In the second example, the anxiety symptoms are a result of the ADHD. So you can see how kids with anxiety disorders are sometimes wrongly labeled as having ADHD. This can be a real problem. ADHD is treated with specific drugs that help kids stay focused and pay attention in school. But ADHD drugs can make an anxious kid feel more anxious or “edgy.” It’s important to treat the right problem. Both anxiety disorders and ADHD can make test-taking very difficult.

Side effects of SSRIs can include headache, stomachache, trouble sleeping, skin rashes, and weight gain. Most side effects do not happen that often. But every once in a while, SSRIs can cause suicidal thoughts (see sidebar). They can cause something doctors call “activation.” When someone is activated, he or she may have trouble sleeping, move around a lot more than usual, or seem very busy. Some people have strong reactions to one SSRI but no reactions to another. So if the first drug your doctor suggests is unpleasant, you may just need to try a different one. It is vital that you tell your doctor about any and all side effects. Not all doctors agree that kids with anxiety should take SSRIs at all. Most doctors believe that psychotherapy

A mental health professional can

help you figure out what is making you anxious and develop a plan to address it.

Tips for Handling Anxiety

The Anxiety and Depression Association of America is a great resource. It provides lots of tips of things you can try.

• Give yourself a “time out.” Take a break and listen to music, meditate, or do some other quiet activity to take your mind off your worries for a while. • Remember that you can’t control everything. You aren’t perfect and you don’t need to be. • Exercise regularly. Some physical activity several times a week will help reduce anxiety. • Try to understand yourself. When you feel calm, think about what kinds of situations make you anxious. What might you do in those situations to feel better?

should be tried first. It all depends on the specific child and how bad the anxiety is. Some kids do well with therapy alone. Others need to take medicine before therapy can help them. Another type of drug given to anxiety patients are benzodiazepines. These drugs have names like Valium, Ativan, and Xanax. The advantage of these types of drugs is that they work very quickly—less than an hour in most cases. For people with very intense anxiety, these drugs can help them to take a first step toward getting better (like going to therapy or a special program). Unfortunately, benzodiazepines can be habit-forming. They also stop working if used for long periods. In addition, these types of drugs can make people feel “fuzzy.” They are therefore generally not used for more than a few weeks at a time.

Psychological Approach Medicine is very useful to treat anxiety, but it is not our only tool. Doctors also treat anxiety with different kinds of psychotherapy. You might have seen someone visit a psychiatrist on a TV show. The character goes to the office, sits or lies down, and talks about whatever is bothering him. This type of therapy can be helpful for some people with anxiety. A more active type of therapy can also be helpful. This approach is called cognitive-behavioral therapy (CBT). The theory behind CBT is that if you change how

Lifestyle Changes

In addition to therapy, there are other things people with anxiety can do to feel better.

• Diet . A healthy diet can help someone feel more calm. • Exercise . Many people find that getting regular exercise can help reduce their overall anxiety. • Relaxation techniques . Yoga and meditation can help you control anxiety, too.

• Alternative therapies . Some herbs and vitamins are thought to help with anxiety symptoms. For example, teas made from chamomile or hibiscus are thought to be calming.

Remember, you should never take any drug or medicine without consulting a trusted adult and your doctor.

you think about certain things, you can change how you feel about them. In CBT, patients try and understand why they think the way they do. Then they practice how to react to those thoughts in better ways. One patient might learn relaxation techniques for when he feels a panic attack coming on. Someone with GAD might learn to separate realistic worries from unrealistic ones. Someone with a panic disorder, who constantly feels in danger, might learn how to remind himself that those feelings of danger are not real. Most of the time, once a person learns which strategies are helpful, she will then move on to what is called exposure therapy . That’s where a patient is exposed to her fear in a controlled situation. Someone who is afraid of flying might

Exposure therapy helps people conquer their fears in small steps. For example, someone with a fear of flying might visit an airport without going anywhere, to get used to the idea.

be shown a photo of an airplane, for example. Someone who has stopped going to school might start going again very gradually. He might just look at pictures of the school at first, and then go to school and walk around the outside of the building. This exposure is done very carefully and slowly. Over time, some people find they stop feeling so afraid. It takes time to change the way you think and react to the world. CBT is not easy. There may even be homework! But it can be very helpful. Through therapy, you can discover tools to help you conquer anxiety—not just for a short time, but for your whole life.

Text-Dependent Questions 1. What are the two main types of treatment approaches for anxiety disorders? 2. Is one better than the other? Why or why not? 3. What is the most common type of medicine used for anxiety disorders? What are its advantages and disadvantages? 4. What other kinds of treatments are available, besides medicine? Research Project Find out more about relaxation techniques. These can include breathing exercises, muscle relaxation, meditation, and visualization (picturing things in your mind). Why might these techniques work? Try some of the techniques that sound interesting to you. Write about how you felt before and after you tried the exercise.