BY LORI ACKEN
Maybe a rough day at the office kept you wide-awake last night. Or a spat with your spouse left you feeling a bit blue. Maybe rainy days and Mondays always get you down (the song came from somewhere, people).
But what if those sleepless nights drag on for weeks, or worse? What if the thought that you did wrong by your lover, your kids, your colleagues or even complete strangers refuses to go away? What if life suddenly seems unmanageable because your brain just … won’t … stop?
Studies show that today’s fast-paced, jam-packed, social-media-driven lifestyles have nearly all of us (even our children) feeling more anxious than ever. But if anxiety rules your daily life — say, stopping you from driving on the highway, trying new activities, seeking a better job or relationship, or it’s keeping you from relationships or work altogether — seeking help is self-care, not stigma.
“I try to emphasize that some level of anxiety is good for you, rather than an emotion to be controlled and/or avoided,” says Dr. Brenda Bailey, an Oconomowoc-based licensed clinical psychologist and clinical supervisor of OCD and anxiety in Rogers Behavioral Health’s residential, partial hospitalization and intensive outpatient programs. “Have to perform in front of others and feeling anxious about it? Good! That means you are challenging yourself and you are growing as a result. Growing and learning are essential in life. … An anxiety disorder can be thought of as a broken threat detection system, in that anxiety alerts us to potential danger when there is not a great threat to our livelihood present.”
Still, says Katherine Krietzer, a licensed professional counselor at Brookfield’s The Center for Anxiety Disorders, our tendency to “normalize” troubling behaviors affects anxiety sufferers young and old. In the latter, people are affectionately labeled worriers. In the former, teachers and family members may chalk those behaviors up to “just a phase.”
“Kids do go through phases,” Krietzer explains. “Two-year-olds lining things up, that’s developmentally appropriate. Phases of separation anxiety and wanting to do really well with homework or other things. But there are warning signs in children that signal that it is going to increase and that it’s going to get worse.
“One of the biggest warning signs that people miss is reassurance seeking … asking the same question over and over again,” Krietzer continues. “That is a pretty significant ritual. [You think] they’re not listening or they’re being funny. Or you think, ‘Maybe I didn’t answer. They just wanted to make sure.’ Intolerance of uncertainty is the driving force of anxiety disorders.”
GAD or OCD?
Even the experts admit that in many patients, discerning obsessive-compulsive disorder (OCD) from generalized anxiety disorder (GAD) can be tricky. Contrary to what you’ve seen on TV, the compulsions OCD sufferers employ to soothe themselves don’t always entail repetitive behaviors such as hand washing, tapping surfaces or organizing objects.
In short, GAD manifests itself in legitimate concerns — making ends meet, performing well on the job, our loved ones’ well-being — while obsessions are frequently unwarranted and intrude on the sufferers’ ability to carry on. “I call generalized anxiety disorder and OCD cousins,” says Aaron Munson, a licensed professional counselor with Cornerstone Counseling Services in Mukwonago and Brookfield. “When someone has GAD and they are worried a lot, it’s actually mental compulsions … constantly reviewing things, constantly giving themselves reassurance in their head. Worrying is a behavior, not an emotion.”
“Most people with even severe generalized anxiety disorder still function,” Krietzer adds. “Most of them still work. Most of them can still get through school. In a severe case of obsessive-compulsive disorder, their functioning completely deteriorates. I’ve worked with kids who haven’t been to school for months. With GAD, a lot of patients just keep going, but they’re miserable, exhausted and they have stomachaches and headaches.
According to the National Institute of Mental Health, OCD is found in 1.2 percent of the American population, though Munson believes those numbers skew closer to 5 percent. Females are more than twice as likely to present with symptoms. And while the disorder is often diagnosed in a patient’s late teens or early 20s, dramatic life changes can trigger it too.
“Maybe a mom who gives birth has always been a bit more on the anxious or worried side, but then once she has a child, the hormonal stuff can increase chances of OCD,” Munson explains. “In that case, she was [likely] still predisposed to it; it just never interfered in her life until the stressor happened.”
Bailey notes that the things we all do to soothe occasional anxieties differ from true compulsions in that compulsions often conflict with the patient’s morals or character.
“For example, some individuals with OCD may have intrusive thoughts of hurting a loved one, such as pushing them down the stairs,” Bailey explains. “We all experience these strange thoughts from time to time, but we just get that strange thought and then move on. Someone with OCD gets stuck on this thought and may try to find meaning in it — ‘Am I a dangerous person?’ Or they may attempt to control it in some way. They may confess these thoughts to the loved one so that the person can know they might be dangerous, or they may avoid being near the loved ones when they are using the stairs.”
Those mitigations ease the person’s anxiety in the short term, says Bailey, but can ultimately reinforce the notion that he or she is dangerous, resulting in more compulsions and trapping the patient in a vortex of pain.
The counselors agree that obsessions without the presence of compulsions — a condition labeled pure obsession or “Pure O” — is, at best, extremely rare.
Breaking Down Treatments That Build Patients Up
Krietzer, Munson and Bailey each specialize in various forms of Cognitive Behavioral Therapy or CBT, which has been evolving since the 1950s.
“The foundation of CBT is the premise that your thoughts, emotions and behaviors influence one another,” Bailey explains. “An important piece of those relationships is that you cannot influence emotions directly. Therefore, we look to change your thoughts and behaviors to change your emotions. In particular, we really focus in on how you can change your behaviors to influence thoughts and emotions.”
Krietzer says that modern exposure and ritual prevention (ERP) therapy — subjecting a patient to the thoughts, images, objects or experiences that trigger them most and teaching them to manage resulting compulsions — has become much less extreme, with equal success.
Munson also notes that newer therapies encourage accepting that, well, sometimes bad stuff just happens. And, sometimes, accepting that you have to roll with the punches is the best way to skillfully dodge a total emotional knockout. “In the last 5-10 years, there’s a lot more focus on something called Acceptance and Commitment Therapy or ACT — we realize that it’s important to challenge our thinking, to change our behavior and recognize that sometimes we can’t change,” Munson explains.
Munson cites a recent mindfulness study that revealed that nearly half the time we are doing something we aren’t focused on our actions, but are rather thinking about the past or the future. Armed with that data, clinicians set to work on a therapeutic model that teaches that living in the moment, even if it isn’t entirely comfortable, is A-OK.
“We try to make room for all emotions and reduce vulnerability to having emotions dictate behavior and potentially make unpleasant emotions worse,” adds Bailey.
The days of long-term pharmaceutical intervention for depression and anxiety-based disorders have given way to the idea that newer medications — particularly selective serotonin reuptake inhibitors or SSRIs — combined with behavioral therapies yield the most effective and lasting results.
Krietzer explains that benzodiazepines (think Valium, Librium, Xanax and Klonopin, which did, indeed, quell anxiety symptoms, but facilitated a host of subsequent horrors, including, many believe, the alarming spike in opioid abuse) have largely given way to short term medications to help patients ease into and embrace behavioral therapies.
“Our psychiatrists are thoughtful in their use of medications with deep specialization in the disorders they are treating,” says Bailey. “ … We want to meet people where they are, offer our expert opinion and knowledge, and allow them to make an educated decision when it comes to medication. We are open and honest about the costs and benefits.”
Looking (hopefully) ahead
Asked about new treatment options on the horizon, both Bailey and Krietzer note the dearth of anxiety disorder specialists outside of metro Milwaukee and Madison, and cite the benefits of the digital era in offering patients — especially those in rural areas — readily accessible relief.
Bailey explains that people who experience anxiety tend to be biased toward “threatening” information, even though they know it triggers obsessions. “We are conducting research at Rogers investigating the use of a smart phone app to address this bias, and collecting data about its effect on OCD symptoms as well as depression,” she says. “If this were to be effective in addressing symptoms, there is the potential to have a form of treatment available, literally, at someone’s fingertips.”
Krietzer and her colleagues at The Center for Anxiety Disorders are turning increasingly to telehealth to better aid clients from as far away as Green Bay and the Fox Valley. The ability to offer an initial in-person consult and occasional face-to-face check-ups, but move key weekly sessions to Skype or other platforms allows more patients to “have a specialist wherever they are,” Krietzer says.
“Research shows it’s just as effective,” she continues. “But there are, obviously, [moral and legal] things you have to be careful of. If people have safety concerns, we’re probably not going to do a lot of telehealth.”
Scientists are also looking to the brain itself to shed light on how best to help it function optimally. Munson cites recent MRI studies that show promise in helping doctors and therapists pinpoint which parts of the brain focus on specific forms of anxiety and OCD, affording better use of medical intervention.
“As great as [current] efforts are, you do have to guess at times,” Munson explains, “so we are trying to find more focused treatments and medical therapies through better neuroscience.” MKE