Therapy in L.A.

  article of the month
June 1999
By Carol Boulware, Ph.D.

This month begins a series on Anxiety Disorders. For the next several months we will describe the different types of anxiety disorders, their symptoms, causes and treatment options. The first in our series is Generalized Anxiety Disorder.
--Editor, Joyce Parker, Ph.D.

  • Do you ever get a sudden rush of fearfulness without any apparent reason?
  • Do you feel anxious or upset about at least one thing every day?
  • Do people say you worry too much?
  • Have you been through a crisis or trauma recently?
About five percent of Americans experience severe anxiety at one time or another in their lives. Only one out of four of them has sought treatment for their disorder. Whether or not you can answer "Yes" to any of the above questions at this point in time, it is a good idea to be aware of the symptoms and causes of anxiety disorders so that you can recognize any future symptoms that you may want to have professionally diagnosed.

We All Worry

From time to time we all worry about things that are important to us. Students worry about their grades, some passengers are nervous when they are boarding an airplane, and even a first date can be nerve-wracking. What job applicant isn't anxious about whether he or she will get the job? Usually, when the anxiety-producing circumstance is over, we are no longer concerned and stop thinking about it. We may experience a sense of calm or satisfaction about the event.

But for some people, the resolution of a problem does not end their mental and emotional distress. They immediately start fretting about something else, and then something else. Their fear becomes the focal point of their daily experience. For these individuals, fear becomes a pervasive force that disrupts their lives or, in some cases, prevents them from functioning normally. Examples are people who take trains or buses to their business meetings across the country because they are afraid to fly. Or persons become so terrified of the "dangers" outside, they cannot leave their houses.

Being afraid is a healthy, normal response. It is a survival mechanism we share with the animal kingdom that keeps us out of threatening situations and preserves our lives. But when fear becomes so intense, so relentless and so overwhelming that it causes great distress and on-going disruption of normal functioning, it is a serious problem that needs to be remedied.

A Wide Range of Causes

Anxiety can be caused by substance abuse or even prescription medications. Sometimes genetics plays a hand. Increased stress is a common cause because most people don't know how to cope with stress effectively. Many anxiety problems are mood disorders can be easily brought under control. Other causes range from childhood trauma, physical illness, witnessing a crime or violence to brain chemical imbalances. Thankfully, today there is an abundance of research to help mental health professionals understand and treat the various manifestations of anxiety disorders.

The five main categories of serious anxiety disorders:

  • Generalized Anxiety
  • Panic Disorder (Panic Attacks)
  • Obsessive-Compulsive Disorder
  • Post-Traumatic Stress Disorder (PTSD)
  • Social Anxiety Disorder (Social Phobia)
Following in this article are general description, symptoms, possible causes, and treatment options for each of these five types of anxiety problems.

Starting this month we will showcase one category a month. This month Generalized Anxiety will be described.


Generalized Anxiety Disorder, or GAD, is not "butterflies in the stomach" but a serious disorder characterized by extreme worry -- and about more than one thing. A person with GAD would have persistent thoughts such as "What if my husband gets hit by a car on his way to the store?" or "What if I get sick and can't take care of my family?" These thoughts might cross anyone's mind, but a GAD sufferer is not able to "shake them off" as others can. They are fixated on the feelings of worry and dread. For these individuals normal anxiety has escalated into a serious problem that needs treatment.

Anxiety disorders affect every aspect of the sufferers' lives -- their activities, their decisions, their health, their businesses or jobs, the thoughts and their family life. When these people are in a stressful situation their anxieties become acute and erupt into symptoms.


Constant worrying, uneasiness, restlessness, a sense of dread, always "keyed-up", fret about health when there are no apparent problems. When faced with a stressful situation, irrational fear. Forgetful or confused. Negative interpretation of other peoples action, feel unsafe.

Physical Symptoms:

  • clenching teeth or jaw
  • tightened muscles
  • holding one's breath
  • sleeping problems
  • racing heart beat
  • breathing difficulties
  • chest pain
  • hyperventilation
  • irritability
Emotional Symptoms:
  • irritability
  • sadness
  • depression
  • low self-esteem
  • loneliness
  • "numb" emotions
  • explosive emotions
  • feeling guilty

An Anxiety Disorder can be brought on by a major life trauma, such as being a witness to or a victim of a crime, physical or sexual abuse, a major illness, or a life threatening experience. Sometimes financial difficulties, grief from a death in one's family or a divorce can trigger anxiety symptoms. These type of "life stressors" are inevitable in life. But for many people, they are the root cause of their anxiety disorders.

Often it is a combination of these stressors that are just too much for some people to handle. Just think how overwhelming it would be to have more than one of these major stresses happen in a short period of time -- the death of a loved one, losing your job and finding out you have a serious illness.

In addition to external stressors, there are internal forces at work that sabotage our sense of peace and well-being. The number one culprit here is negative self image. When a person is highly self-critical and doesn't allow themselves to be simply "a human being being human" it can spell trouble in terms of emotional health. This is tantamount to holding yourself hostage -- without a ransom demand -- because you don't deserve to be rescued! Obviously, these types of destructive self-thoughts are a vicious cycle of misery that need to be treated by a professional counselor.

Treatment Options

Fortunately, there are many avenues of successful treatment for the full spectrum of anxiety disorders. Behavior Therapy and Cognitive Behavior Therapy are very helpful treatment methods. For some people sessions of psychotherapy can help a person understand the root causes of their disorder. Relaxation methods such as meditation, breathing techniques and visualization can help relieve symptoms.

Anti-anxiety drugs such as Xanax can bring relief of anxiety symptoms.

© Copyright 1999 by Carol Boulware, Ph.D.

For more information, please call: Carol Boulware, Ph.D. (310) 395-3351

Offices: Santa Monica & Redondo Beach, CA

Dr. Boulware is a Cognative Behavior Therapist and has Advanced Level II training in EMDR. She practices in Redondo Beach and Santa Monica. She is a member of the Independent Psychotherapy Network.

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