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From the Publisher – A Look into the World of Anxiety Disorders

I felt that it would be useful to our readers that we devote this issue of Mental Health News to taking a fresh look into the world of anxiety disorders. We last visited this topic in our Winter 2006 issue. At that time The National Institute of Mental Health (NIMH) estimated that 19 Million American adults suffered from anxiety disorders. Today, as reported in our cover story, NIMH estimates that anxiety disorders affect about 40 million American adults age 18 years and older. This represents about 18% of the US population in a given year. That is a substantial increase in only four years. Perhaps this is due to better diagnoses and reporting of anxiety disorders.

In our other cover page article entitled Anxiety: The Rust of Life, Robert M. Lichtman, PhD, gives us a good description of the way anxiety feels. “Anxiety can be described as an autonomic or automatic response that is not under our direct control, when we are exposed to a present or future stressful event. We begin to experience an uncomfortable sensation within our own skin. The physical presence is akin to a low voltage of electrical current pulsing throughout our bodies. It is usually triggered by a seemingly ever-present issue that remains with us until that which is worrying us is resolved. Worry becomes a label applied to an actual physiological arousal that begins in the thinking part of our brains.”

Anxiety disorders are serious and often highly debilitating forms of mental illness. In this issue of Mental Health News, we had the good fortunate of having an opportunity to interview two highly respected clinicians in the field of anxiety disorders. They are Helen Blair Simpson, MD, PhD, Director of the Anxiety Disorders Clinic at the New York State Psychiatric Institute (NYSPI), and Ann Marie Albano, PhD, ABPP, Director of the Columbia University Clinic for Anxiety and Related Disorders (CUCARD). Both Drs. Simpson and Albano provided a fascinating look into many aspects of anxiety disorders and provide some very useful answers to questions many of us have about anxiety disorders.

In my discussion with Dr. Simpson on page eight, she explains how parents detect early warning signs of an anxiety disorder in their children. “Some parents are very aware. Some parents who have suffered with anxiety disorders themselves are very attentive to these issues in their children and are very proactive in alerting us. Unfortunately, some parents who have suffered themselves feel guilty and think “Have I passed this on to my child – have I given them bad genes – are they destined to get my illness?” To me that’s very sad, because the parent is suffering twice – for themselves and with worry for their child. The positive side of this is that they know what some of the early warning signs are and if they have been helped by the mental health profession in the past themselves, they are less worried about bringing their child in to early intervention for help, and they are usually less concerned about stigma. Other parents that have no experience with anxiety disorders or have it themselves and have never had it treated, can actually be very frightened of seeing this in their child, and don’t often come into the clinic as often as they might, for a whole host of reasons. It might be that to have an anxiety disorder diagnosed in their child may mean it then becomes diagnosed in them. And then there are those parents who don’t believe treatment can help or that if they bring their child in, someone will insist that their child be placed on medications. In fact, the first line of treatment for anxiety disorders in kids is Cognitive Behavioral Therapy (CBT) which can be highly effective in many children. I would argue that if CBT isn’t enough for your child and your child does need a trial of medication – if it helps keep your child in school with friends and going through normal developmental stages so they don’t go off track – you need to balance that against the concerns you have about medications – some of which can be very safe.”

In my interview with Dr. Albano on page nine, she discusses how childhood anxieties surface in the classroom. “The thing about school is that it is a wonderful diagnostic laboratory. Every day, kids have to go between eight in the morning until three thirty in the afternoon and through the course of their development they are bombarded with developmental challenges. They have to learn how to raise their hands, ask questions, get along with other kids, become part of the peer group, and how to negotiate multi-tasking. All of these things happen during the course of school and for the kids with anxiety, they are very clear about telling us time and time again, “I sit in school, I watch the clock, and I wait for the bell to ring.” They are doing that with their stomach in knots, by trying to avoid eye-contact with the teacher, and they are making themselves as invisible as can be. When a kid comes home and the parent asks, “How was school today?” and the child just says “fine,” parents really need to find out what that really means. It might mean “fine” because nobody bothered me, and that’s something we don’t want children to experience in that way.”

On page 14, Rachel Goldstein, MD, of NewYork-Presbyterian Hospital discusses OCD and Anxiety in Postpartum Mothers. She states that, “Untreated OCD during pregnancy is also a risk factor for postpartum depression as well. Some women do well off medication during pregnancy but may experience an exacerbation post-partum. Optimally the women with a diagnosis of OCD will take the opportunity to consider her options and preferences in advance of becoming pregnant while medication reduction or changes can be considered and when CBT skills and other therapy can be introduced if this had not been done before.”

In a very interesting article on page 18 from The Jewish Board of Family and Children’s Services (JBFCS), colleagues Martha Spital, LCSW, Sararivka Liberman, LCSW, and Susan Trachtenberg Paula, PhD, discuss how Cognitive-Behavioral Therapy Helps Clients Cope with Anxiety Disorders. They report that, “The good news is that anxiety disorders are very treatable. Yet only about a third of those who have an anxiety disorder get help. Cognitive behavioral therapy, or CBT, is considered the gold standard for the treatment of anxiety disorders, and is a well-researched, highly effective, and lasting treatment. A large number of peer-reviewed, controlled studies have demonstrated that CBT alone can greatly reduce anxiety symptoms. In some cases, however, CBT with medication produces the best treatment outcomes.”

On page 30, Miki Yoshida, LMSW, at the Treatment Center for Trauma and Abuse at Westchester Jewish Community Services (WJCS), tells us that she is helping clients with PTSD through the use of Yoga. “As people practice yoga, they develop skills to pay closer attention to themselves without judgment, and to accept each moment as it comes. People can experience a sense of calmness and contentment with yoga.”

As you will see, we have many other wonderful articles of interest in this issue. We also have an exciting lineup of themes on schedule for our upcoming summer, fall, winter, and spring issues. They are listed on page four in our table of contents and on page 43. Our summer issue will take a look at the theme “Addressing the Needs of Caregivers” We are looking for articles relating to the needs of treatment professionals, family members, and the problem of who will continue to care for older people with mental illness when their aging parent caregivers pass on.

I want to thank everyone who helped make this issue of Mental Health News possible. I hope you will continue to write to me at iraminot@mhnews.org and tell me what topics are important to you. Your participation is an essential part of the success of this newspaper.

Good Luck in Your Own Recovery

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