Who Can I Talk To About My Anxiety?

Who Can I Talk To About My Anxiety?, should you see a doctor for anxiety, what happens when you go to the doctor for anxiety, anxiety symptoms

“Who can I talk to about my anxiety? ” That is a question that a lot of people struggling with anxiety symptoms and feelings of stress ask.  Anxiety is something that you might experience repeatedly over the course of your lifetime.  It might really feel like part of your lived experience.

For some people, anxiety feels inherited.  Sometimes, anxiety feels like it is a common part of a household growing up.  In this way nature vs. nurture doesn’t matter.  You just know that anxiety is familiar.

For others, anxiety feels more time-specific. You go through something uniquely stressful in your life and it brings up anxiety.  Maybe it’s getting ready for a big test that is really important for your future.  It could be experiencing something traumatic that leaves you afraid of facing an experience again.  Examples might include fears of driving, animals or insects, or getting a shot or having blood drawn.

Regardless of the reason, frequency, type or specificity  – you want to know who you can talk to about your anxiety to start feeling better.  First, we’ll help you consider when you should see a doctor for anxiety.  Then, we’ll cover what happens when you talk to your doctor about your anxiety.  Finally, we’ll review the different types of anxiety therapists and doctors,  and the kinds of treatments that they provide.

Should You See a Doctor for Anxiety Attacks?

The first question to consider is whether you should see any doctor at all for anxiety attacks.  By ‘anxiety attacks’, we could be referring to specific panic attacks – which are sudden and intense physiological expressions of anxiety – or more general anxiety symptoms.  You probably wouldn’t be reading this if you weren’t at least thinking about it, right?    Fortunately there are usually a lot of different types of doctors who treat anxiety near you.  For example, you can see a psychiatrist or psychologist for anxiety, or even your general physician.

For people who don’t have experience with or knowledge about therapy, they may first think of raising their anxiety with their general doctor, also known as a primary care physician (PCP).   This is the person whom you would see for a range of physical and medical health issues.  But these symptoms can also overlap with psychological issues.  And most general doctors have some practical experience recognizing mental health issues.

What Happens When You Go to the Doctor for Anxiety?

It is important to know what happens when you go to the doctor for anxiety.  A primary care doctor will examine you and ask you to tell them more about why you are at the office.

Oftentimes this informal chat, and the follow-up therapeutic questions they will ask, are just as important in making an anxiety diagnosis as the physical exam in the visit.  In diagnosing anxiety, a primary care doctor is going to be looking for physiological symptoms of anxiety.  They will also be listening for examples of worry and obsessive rumination – anything that’s of a more cognitive or emotional kind of expression of anxiety.

Anxiety Symptoms

This article is not meant to be an exhaustive summary of all anxiety symptoms.  But here are some general example of types of anxiety symptoms:

Physical anxiety symptoms.  Examples include racing heart, excessive sweating, flushed or red face, irritable stomach or gastrointestinal symptoms, difficulty breathing, and crying.

Panic disorder, which features panic attacks, often involves symptoms such as these.  Panic attacks can feel like they are coming out of nowhere.  But there are usually underlying issues that bring on the first panic attack.  Often afterwards, because of the combination of fear and confusion, people mistakenly fear the panic attack itself.  In such instances, they are likely to then try to avoid having it again, which in turn increases the likelihood of further panic attacks.

Physical anxiety symptoms are also quite common with phobias.  In extreme examples of phobias, such as needle phobia, people may have a vasovagal response, in which they faint or pass out in response to the cue.  Agoraphobia, or fear of leaving the home, is also commonly associated with strong physiological anxiety symptoms.  Social Anxiety Disorder, which refers to anxiety about interpersonal interactions, can also involve physiological symptoms of anxiety.

Generalized worry.  Some people have ‘overactive minds‘.  They might shift across different topics in what they worry.  However, no matter the topic, it’s almost like their mind is looking for something to worry about.  This type of presentation is often the case with Generalized Anxiety Disorder.

Mental rumination.  Others may focus on a specific issue and worry about it incessantly.  It’s almost like their minds get ‘stuck’ on an issue, obsessively reviewing it.  Usually, the intention may be good, but it can feel like you are out of control because you just can’t let it go.

Compulsive behavior.  Ritualistic behaviors, where a person repeats a behavior repetitively, are also a type of anxiety symptoms.  Sometimes the compusive behavior is because the person worries that they have forgotten to do something, such as in the case of doorknob checking.  Other times, the behavior may have a superstitious quality to it, such as when a person feels compelled to do a behavior for the purpose of ‘releasing’ an anxiety.

Who to Talk to About Anxiety?

Although primary care physicians may be the first person that patients talk to about anxiety, they don’t have to be.  In fact, I would argue that for those who are knowledgeable about anxiety treatment or are willing to do some research, it may be more advantageous to directly reach out to a psychiatrist, psychologist, or therapist.  General doctors may do the ‘triage’ of initial screening, but psychiatrists are far more specialized and skilled in assessing anxiety symptoms and recommending medications that would be a good fit.

Similarly, psychologists will have more in-depth training in assessing and treating anxiety with psychotherapy.  Psychologists and therapists provide ‘talk therapy’ about anxiety.  Psychologists often have significant training in specialized therapeutic treatments of anxiety.

So in sum, there are a lot of different types of doctors who you can talk to about your anxiety.  If you’re primarily interested in medication for anxiety, see either your primary care physician or a psychiatrist.  If you want therapy for your anxiety, you can see a psychologist or therapist (and in some cases a psychiatrist).

Anxiety Treatment

After making a diagnosis, a doctor will either prescribe a medication to treat your anxiety symptoms and/or recommend therapy for your anxiety.

For ‘anti-anxiolytic’ medication, doctors usually recommend either a selective serotonin reuptake inhibitor (SSRI), tricyclic antidepressant (TCA), or benzodiazepine medication.  While benzodiazepines are often associated with anxiety medication in popular culture because of their rapid symptom relief, they have a number of side effects and adverse long-term effects.  For this reason, usually anti-depressants, such as SSRIs and TCAs, are the first line of anxiety medications to be prescribed.  Although they are often associated with treatment for depression, these medications can often be effective ‘off-label’ prescriptions for anxiety, with less side effects.

Additionally or alternatively, many primary care physicians have a list of recommended psychologists and therapists whom they will refer to their patients for therapy.  For some people, this referral may be their first personal introduction to therapy, and is often how they get started with the process of therapy.

Examples of different therapeutic approaches for anxiety include Cognitive-Behavioral Therapy (CBT), Exposure Therapy, Psychodynamic Therapy, mindfulness, hypnosis, relaxation, and psychoeducation.  Therapy can be done in person or by teletherapy.

What to Talk about in Therapy for Anxiety

Knowing what to talk about in therapy for anxiety isn’t always as straightforward as it might seem.  In symptom-focused anxiety treatment, the emphasis is on developing methods to decrease your anxiety symptoms.  Mindfulness, hypnosis, diaphragmatic breathing techniques, and progressive muscle relaxation are examples of methods to deal with somatic manifestations of anxiety, such as in the case of panic disorder or social anxiety.  On the other hand, CBT techniques such as ‘worry time’ and ‘thought stopping’ help with rumination frequently seen in generalized anxiety disorder and obsessive-compulsive disorder.  Exposure therapy is a popular and empirically-supported treatment that is used when anxiety is caused by an initial pairing, repetition, and generalization of a stimulus and anxiety response.  Avoidance causes the negative valence of this pairing to persist rather than decrease.  Through exposure, the process of repeating the stimulus with no effect breaks the intensity and frequency of the anxiety response.

On the other hand, a careful therapeutic process of listening and inquiry can be every bit as important in knowing what to talk about in therapy for anxiety.  Oftentimes, anxiety may be the product, or even defense against, deeper underlying experiences and emotions.  Insight-focused anxiety treatment focuses on helping clients to better understand how their past and present intersect in ways that cause them distress.  Identifying patterns, developing insights, and experiencing previously repressed or unexpressed feelings such as sadness can also be an important part of resolving anxiety.

Be proactive and don’t wait for your anxiety symptoms to worsen.  Take the initiative and contact a doctor or therapist to talk to about your anxiety.  Remember that combined treatments (medication and therapy) can be especially effective.  Other times that is not necessary, and either therapy or medication is all that is necessary to resolve your anxiety symptoms.

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Eric- Spiegel - Attune Philadelphia Therapy Group