The Anxiety Question

November, 29 2012

Moment’s 2012 Elephant in the Room Contest, in partnership with the Andrew Kukes Foundation for Social Anxiety, asks readers to respond to the question: How has anxiety affected you, your family or the Jewish people in general? We spoke with Alies Muskin, executive director of the Anxiety and Depression Association of America, about anxiety and the ADAA’s work on reducing the stigma surrounding mental illness. Below is a lightly edited transcript of the conversation.

Is anxiety well understood by the public?

It’s fairly well understood. We’ve done some surveys over the years that show that there’s an increased awareness prevalence in the media—shows like The Sopranos and Monk. There’s awareness, but there’s a lot of stigma. We’ve done surveys where we’ve asked people, “If your disorder affects you so that you can’t go to work or need to leave work, do you tell your boss the real reason that you’re leaving?” Most people say no. More awareness doesn’t mean that more people seek treatment. There’s a young basketball player named Royce White [who suffers from an anxiety disorder]. Someone wrote a blog basically saying that what he has is real, that he needs to get help and treatment, that this is disabling and the tweets back to that blog are like, “Buck up, you’re getting paid millions,” or, “This is all made up, there is no such thing as this disorder.” It’s pretty horrifying. That’s where the stigma comes in.

How can the stigma be reduced?

Organizations like the Andrew Kukes Foundation for Social Anxiety and our organization do a lot. We’ve been around for 33 years, and we’ve done multiple campaigns over that time to help reduce stigma. One campaign doesn’t erase it. It’s constant education. We have a very deep, broad website about anxiety disorders and depression that explains what treatment is and helps people find trained, qualified, licensed providers. We tell people what to expect when they go for treatment; we have videos, we have podcasts and brochures. We give people as much education as possible. When I tell people what I do for a living, people always say to me, “I know someone who has an anxiety disorder,” or, “I have a family member who suffers from panic attacks,” or, “I’ve struggled with this.” For me it’s certainly an icebreaker, but the stigma is huge.

How has awareness of anxiety changed?

Thirty years ago, all there were were phobias. You had phobias and a couple of other categories. It wasn’t until 1990 that the term “anxiety disorder” was coined by the American Psychiatric Association. Panic disorders and obsessive-compulsive disorders and others were put into that category. It grouped together different disorders that share a commonality in their underlying neurological and biological mechanisms.

When does normal anxiety become problematic?

General anxiety is when you have a paper due, or you applied to several jobs and you’re waiting to hear. Everyone has anxiety. It’s absolutely normal—it’s what keeps people from walking into the street without looking both ways. People are able to handle different levels of anxiety—a firefighter who can run into burning building is different than I am. Then we have people who have a disorder. A disorder is not just a lot of anxiety—it doesn’t just happen because suddenly you’ve lost your job. A disorder has diagnostic criteria. People with the disorder are people whose lives are disrupted. They either worry all the time, or they worry incessantly about things about things that might happen to them if they don’t do other things. Their daily life pattern is disrupted—you need to add an hour to your day to get ready in the morning, just because you’re going to lock and relock your door. Or someone who literally cannot get up and speak, and will avoid it at the cost of a promotion or a raise. Or the person who has a needle phobia and won’t go for prenatal care, or won’t go for cancer treatment

What’s available in terms of treatment?

There are many treatment options, and they’ll differ depending on what the diagnosis is. In general, there are FDA-approved medications for treating anxiety disorders. Our recommendation is always that somebody sees a mental health professional, even if the prescription is written by another physician. There are good cognitive and behavioral therapies. Something called DBT (dialectical behavior therapy) is another form of treatment. There’s ACT (acceptance and commitment therapy) and exposure therapy. Somebody who might be afraid of elevators would do exposure therapy with a therapist who’d slowly expose them and make them understand what’s happening to them, and then expose them to being on an elevator. All of these therapies are short-term; you’re not going into analysis. We’re talking about a few months and maybe some tune-ups every now and then. If you really go to somebody who’s trained in these kinds of anxiety disorders, in a few months you should learn all the skills you need to manage your anxiety disorder. On our site, we have a list of questions to ask a therapist the first time you see them. One of the questions you should be able to ask someone is, “How long before I can expect to see some improvement?” and “Tell me in general what you think the course of treatment will be and how long this will take.” You and your therapist should be able to set up targets. We think that’s a very important way to evaluate whether or not you’re getting better and whether or not this therapist is able to help you get the treatment you need.


For more information on finding a treatment provider, or for information on options for those who need care and don’t have insurance, visit the Anxiety and Depression Association of America’s website.

The Elephant in the Room Contest is accepting entries through December 7. Three winners will each receive an iPad and will have their work published in Moment. Read more and enter the contest here.

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