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Anxiety: Part I - Lions & tigers &... clowns? Oh my!

As we enter the month of October, let's change gears from the topic of memory loss and dementia and focus for a moment on anxiety disorders instead. After all, Halloween is just around the corner and with this holiday comes a deluge of horror movies, scary costumes, and other fear-provoking stimuli. As a matter of fact, a news report was released in south Florida just the other night that warned parents of a "creepy clown" threat- an Instagram post that pictured a clown with a caption beneath that described a plan to attack all of the principals, teachers, and children in the Palm Beach County school system. Would you say that this threat provoked anxiety? Fear? Panic? Or all of the above?

The Diagnostic and Statistical Manual of Mental Disorders (DSM-5) defines anxiety as the anticipation of a future threat. In other words, anxiety could also be described as a sense of impending doom or a feeling that something bad is going to happen... even when there is no specific threat or indication that any such event will occur. On the other hand, the DSM defines fear as the emotional reaction to a real (or perceived) threat of something that is either imminent or already present. Moreover, fear is frequently associated with the flight-or-flight response, which is your body's physiological reaction to danger. This can include symptoms such as an elevated heart rate, sweating, trembling, dizziness, nausea, and more. To some degree, physiological reactivity is important, as it can serve the protective function of sounding an alarm to warn us of danger. In other cases, however, physiological reactivity can be excessive and may even cause a person's body to sound off false alarms. Rather than being adaptive and promoting survival, you may feel like you are "going crazy" or "losing control" of yourself. When this happens repeatedly and to the extent that it is interfering with your day-to-day activities, then what you are likely experiencing is a panic attack.

It is estimated that 30-40% of people who have no history of a mental health disorder will suffer from a panic attack in any given year. While anxiety can vary in intensity from mild to severe, panic attacks are typically more debilitating and may even prompt visits to the emergency room. However, I can assure you that you will not die from a panic attack! Yes, you will likely experience a number of extremely unpleasant sensations but (unless you have an underlying heart condition or congenital defect) you will survive it. And there is more good news: Numerous studies show evidence that panic attacks, in addition to other symptoms of anxiety, can be effectively treated with cognitive-behavioral therapy.

So what exactly is cognitive-behavioral therapy? Rather than just talking about your problems, CBT usually involves a plan or action that requires some degree of effort and commitment on your part as a patient. This action-component can range from an in-depth examination of your thoughts and beliefs to the completion of homework assignments during which you gradually expose yourself to the very thing that you fear. Generally speaking, anxiety is a perfectly normal response to feeling vulnerable about situations that are outside of your control. How a person deals with that anxiety (e.g. avoidance or panic) is where things have a tendency to go astray. So let's take back some of that control. Let's focus on the things that we CAN do to reduce our body's reactivity and to think more clearly when faced with a crisis. Life is more than the "what if's" and worst-case scenarios, but we can learn to be better prepared for them when they happen.

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