Millions of individuals live each day in fear – not of an actual physical threat, but imaginary dangers, remembered trauma, inanimate objects, or something as simple as walking outside their front door.

The most common psychiatric illnesses today are anxiety disorders.  Estimates place the number of affected Americans at up to 40 million. At least 18% of adults and 13% of children suffer from some type of anxiety disorder in a given year.

The Nature of Anxiety Disorders

We all experience brief moments of anxiety during stress.  In order to be considered an actual disorder, anxiety symptoms must be intense and frequent.

Mental health professionals recognize six different types of anxiety disorders:

  • Obsessive-compulsive disorder – continual disturbing thoughts and/or the need to perform ritualistic behaviors;
  • Generalized anxiety disorder – excessive, unrealistic worry or tension without apparent cause;
  • Post-traumatic stress disorder – frightening thoughts and memories after a traumatic event, often with emotional numbing;
  • Social anxiety disorder – overwhelming self-consciousness or phobia about being in social situations;
  • Panic disorder – sudden feelings of terror, often with incapacitating physical symptoms;
  • Specific phobias – intense fears of specific situations or objects.

Excessive fears or feelings of dread are common to all types of anxiety disorders.

Common Symptoms

While clusters of symptoms vary with the type of anxiety disorder, individuals with severe anxiety may experience:

  • Persistent feelings of panic, fear, or dread;
  • Obsessive thoughts;
  • Ritualistic, compulsive behaviors;
  • Flashbacks to traumatic experiences;
  • Feelings of losing control;
  • Frequent nightmares;
    • Intense fears in public situation;
    • Intense fears of certain objects or activities;
    • Physical symptoms such as shortness of breath, heart palpitations, nausea, muscle tension, dizziness, or dry mouth.

Causes and Risk Factors

Many factors may influence the development of an anxiety disorder.  They include genetic tendencies as well as such environmental factors as repeated exposure to stressful events or one major traumatic event. Even certain medications, including antihistamines, oral contraceptives, and insulin, have been found to trigger anxiety.  As with most mental illnesses, anxiety disorders appear to develop from an interaction of many medical, genetic, psychological, and environmental factors.

Anxiety disorders can affect anyone and often occur in conjunction with other physical and mental illnesses. Women are diagnosed with anxiety disorders more frequently than men.  No differences in prevalence have been noted across races or cultures.

Anxiety Treatment

Treatment of anxiety can greatly reduce or eliminate symptoms in most individuals.  Primary treatments for most anxiety disorders include medication and psychotherapy.  Treatment can usually be provided on an outpatient basis, although brief residential or inpatient treatment is sometimes needed, depending upon the individual’s unique needs.

Medications used to treat anxiety disorders include a variety of antidepressants and anti-anxiety drugs.

Cognitive-behavioral therapy is the preferred type of psychotherapy for severe anxiety.  Through therapy, patients learn to recognize unhealthy thought patterns and behaviors associated with their anxiety and to change both faulty thinking patterns and their reactions to “trigger” situations.

In addition to medication and psychotherapy, treatment may include relaxation therapy, changes in diet and lifestyle, and education on the illness for both patients and their families.

While anxiety disorders cannot be prevented, people can often reduce symptoms by limiting caffeine consumption, avoiding over-stimulating medications or supplements, and seeking immediate support or counseling after a traumatic experience.

Through proper treatment and symptom management, millions of individuals affected by anxiety disorders can lead fulfilling lives again.

Patients with obsessive-compulsive disorder (OCD) frequently experience problems with disturbing, intrusive thoughts, as well as overwhelming impulses to perform ritualistic behaviors that reduce the anxiety associated with such thoughts. Traditional psychotherapy has not been found to be helpful for most individuals with OCD.  However, one modern form of treatment is particularly successful in overcoming symptoms of the disorder.

The nature of cognitive-behavioral therapy

OCD patients typically become distressed about negative thoughts or obsessions, because they see them as warnings of potentially dangerous events. Cognitive –behavioral therapy (CBT) helps patients identify such unrealistic thoughts and reinterpret them, thereby reducing anxiety.  Fewer anxious thoughts lead to decreased compulsive behavior.

How does CBT work?  Treatment focuses on helping patients examine the relationship between their feelings, thoughts, and behaviors. Using a collaborative and structured approach, therapists guide patients to explore and expose themselves to their fears and anxieties in a controlled and safe environment.  The beliefs surrounding those fears are also identified, challenged, and ultimately changed.

Patients learn to recognize their worries as being obsessions and to see their rituals as compulsions. Treatment includes a variety of structured techniques and strategies.


Working on assignments between therapy sessions is an important part of the treatment process.  Patients are usually asked to keep a journal or “thought record” of their obsessions, in which they write down each one when it occurs, as well as their interpretation of its meaning.  The therapist reviews the journal with the patient and helps challenge any unrealistic beliefs or “magical thinking” that surrounds the obsessive thoughts.

Behavioral Experiments

Once a patient understands the relationships between thoughts and behaviors, therapy may progress to the use of behavioral “experiments,” in which the patient practices what has been learned.  An individual who believes that touching a doorknob three times will prevent her house from burning down may be asked by her therapist to touch it only once, then leave the house.  She will then see that nothing catastrophic happens.

One effective type of behavioral experiment is the use of exposure and ritual prevention.  This technique involves a patient’s prolonged exposure to a distressing situation or object, along with strict prevention of any associated ritualistic behavior.

First the patient is exposed to a situation or cue that stimulates obsessive thoughts. For example, a patient with a germ obsession may find that touching a faucet in a public restroom triggers thoughts of contracting a fatal disease. These thoughts, in turn, lead to compulsive hand washing. During exposure, the patient may actually touch the restroom faucet, while imagining the possible horrible consequences associated with this action.

Following exposure to the triggering obsessive thought, the patient is asked to abstain from performing the behavior believed to prevent the feared consequence; e.g., ritual hand washing. After several exposures, followed by no performance of the compulsive act, the patient realizes that the feared consequence does not occur if the compulsive act is not performed.  More importantly, the patient realizes that distress and anxiety can lesson even without performance of the ritualized behaviors.

Finally, the patient and therapist process the patient’s experience during or after the experiment and discuss how the experience affects the patient’s beliefs and fears.

CBT is generally successful as a short-term therapy, and it has achieved very positive results with a variety of patients.

Constant hand washing, repetitive touching of doorways, checking ten times to make sure the stove is turned off:  these are all examples of behaviors we frequently associate with obsessive compulsive disorder, or OCD.

The nature of obsessive compulsive disorder

OCD is a type of anxiety disorder, characterized by unwanted, uncontrollable thoughts as well as repetitive or ritualized behaviors.  While the thoughts and actions are irrational and unproductive, the affected individual is unable to resist the urge to express them.

An obsession is a frequent and uncontrollable impulse, thought, or mental image that an individual experiences.  They are often quite disturbing or unpleasant, as well as distracting.

A compulsion is a behavior or ritual that an individual repeatedly completes as a way of trying to make an obsessive thought go away.  Individuals with obsessive thoughts about being unclean may wash their hands until they are raw.  However, compulsive behavior not only does not reduce an obsession; these frustrating and time-consuming acts usually increase anxiety.

Treatment of obsessive compulsive disorder

OCD is a mental disorder that responds successfully to treatment.  The two most effective types of OCD treatment are cognitive-behavioral therapy and medication, often used in combination.

Cognitive-behavioral therapy, or CBT, is a type of psychotherapy that involves retraining one’s thought patterns so that compulsive behaviors no longer feel necessary.

Two CBT components are most effective in treatment of obsessive compulsive disorder:

  1. Exposure and response prevention, or ERP, is a treatment that involves repeated exposure to a source or common cue for an obsession, while the individual refrains from the associated compulsive behavior.  Using the previous example of compulsive hand washing, an individual might be asked to repeatedly touch a public restroom’s door handle and then be prevented from hand washing.   Gradually the individual learns that nothing catastrophic occurs when the behavior is not performed. The more an individual is exposed to an anxiety-provoking trigger without incident, the more the association weakens. ERP is a therapy based upon literally facing one’s fears.
  2. Cognitive therapy focuses on the obsessive thoughts themselves.  Individuals with OCD often think of “worse-case” scenarios or experience an exaggerated sense of personal responsibility for things they cannot really control; e.g., a plane crash. Through “cognitive restructuring,” harmful thought patterns can be challenged and healthier, alternative ways of thinking can be developed. For example, the hand-washing individual may explore the underlying belief prompting this behavior, such as “I am unclean.” Once an unrealistic belief is discovered and challenged, the need to engage in the anxiety-reducing behavior may disappear over time.

Medication has also been found to be effective in obsessive compulsive disorder treatment for many individuals.  Some psychiatric or psychotropic medications help control obsessions and compulsions.  These include antidepressants that increase serotonin levels in the brain, which may be low in individuals with OCD.  Medication, if indicated, is normally used in conjunction with psychotherapy.

Professional treatment for OCD is highly effective, with research findings of long-term recovery rates of up to 75% or more.  With proper intervention, individuals struggling with the anxiety and frustration of obsessive compulsive disorder can resume productive lives.