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Ask Us Anything About… Anxiety

Everyone feels nervous sometimes – but when anxiety begins to interfere with everyday activities, it's time to get help. Learn about the various types of anxiety and how they can be controlled from Dr. Timothy Zeiger, a clinical psychologist at Penn State Health Milton S. Hershey Medical Center.

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Description – The video begins inside the Penn State Health Medical Group office – Outpatient Psychiatry Clinic. Two individuals are standing together looking at the camera. From left to right is Scott Gilbert and Dr. Timothy Zeiger.

Scott Gilbert  – From Penn State Health, this is Ask Us Anything About Anxiety. I’m Scott Gilbert. Well, occasional anxiety — it’s a normal part of life. We may experience it before taking a test or right before we get up to give that big presentation at work. But anxiety disorders are not temporary and for people who have them, the feelings of anxiety they get can get worse over time and even interfere with basic daily activities. We’re going to talk about anxiety today with one of our experts here at Penn State Health. It’s Dr. Timothy Zeiger. He’s a psychologist. Thanks so much for your time today. Let’s start by talking about how you do distinguish what we might think of as normal, everyday anxiety with something that is a little more associated with an actual disorder.

Dr. Timothy Zeiger – Sure. I think what distinguishes everyday anxiety from anxiety that turns into something that we would label a disorder is how it impacts someone’s day to day functioning and quality of life. So for example, in very extreme cases people can’t leave the house. They can’t do basic activities that they used to do without this overwhelming fear such as going to the grocery store or driving somewhere that they drove maybe a hundred times before.

Scott Gilbert  – So that’s when you know that it’s reached a point where you might need some help, then. I want to talk a little bit about the flip side, though, because I’m thinking of people like athletes and others who actually thrive under pressure, and the nerves and anxiety in particular situations can actually be a good thing?

Dr. Timothy Zeiger – Yeah, absolutely. Anxiety sometimes is a very positive thing and can help us too and actually enhance our performance. So I think sometimes if we’re a little bit too casual or too laidback before that big sporting competition or before that big exam, we’re not going to be fully prepared to be able to perform at our highest level.

Scott Gilbert  – You’re watching Ask Us Anything About Anxiety from Penn State Health, Milton S. Hershey Medical Center. I’m Scott Gilbert alongside Dr. Timothy Zeiger and we welcome your questions in the comment field below this post. As we always say, whether you’re watching this video live or on playback, we can track down some answers for you. So do feel free to add any questions you have about this important topic. I’d like to break down the various types of anxiety, starting with generalized anxiety disorder. What are — what’s that all about? What are some of the signs of that?

Dr. Timothy Zeiger – Yeah, generalized anxiety is just your kind of everyday anxiety. So that can be things like fear of going to a movie for fear of criticism. Or you know, anxiety about a test or a performance.

Scott Gilbert  – OK. How about panic disorder? What are some of the traits of that?

Dr. Timothy Zeiger – So that’s people who have — it can be acute or nonacute so it can be triggered by specific things in the environment. So again, such as taking that exam or just kind of things out of the blue. So for these people there can be physical symptoms such as, you know, shakiness, shortness of breath. They can feel like they’re entrapped. So those are often symptoms of panic disorder.

Scott Gilbert  – You know, one situation that comes to my mind is even speaking on camera or giving presentations. Some people are fine in any other setting, but you put them in front of a camera — which you’re doing great, by the way. But you put some people in front of a camera and they just, they have what you could consider to be a very illogical fear of doing that or speaking to large groups of people. Is that a common — Something to worry about if you have —

Dr. Timothy Zeiger – Where someone may be prepared mentally to kind of get up there and perform and once they get up there they just kind of freeze and they begin to experience a multitude of symptoms cognitively, emotionally, behaviorally, and it can just kind of be overwhelming for them.

Scott Gilbert  – And I mentioned phobias briefly. I want to delve into that a bit more because how, when we talk about anxiety, how does it factor in when we think about people who may be afraid of spiders or the number 13 or heights?

Dr. Timothy Zeiger – Yeah, I think when we think of anxiety disorders, specific phobias, phobias are probably the most highly kind of publicized in popular media. So like you were saying, fears of spiders, fears of heights. They’re very, very common and something that we see on a regular basis.

Scott Gilbert  – Now one type of anxiety we haven’t touched on yet is social anxiety disorder. Can you tell us what that is?

Dr. Timothy Zeiger – Yeah, social anxiety disorder is, again, when we look at somebody’s quality of life or quality of interaction being impaired by their anxiety. So it’s people who have difficulty kind of interfacing back and forth with other people for, you know, fear of criticism or judgment. That’s what that looks like.

Scott Gilbert  – OK. You’re watching As Us Anything About Anxiety from Penn State Health. This is Dr. Timothy Zeiger. He’s a psychologist here. We’re at the Northeast Drive location for Penn State Health and we welcome your questions or comments wherever you are, whatever your question is. Feel free to pose those questions about anxiety and we’ll get you some answers here. And also, if you find this content valuable, as we hope you do, please do share it on your Facebook feed to help get this information out to even more people. I’m curious, Dr. Zeiger, as to whether there are certain risk factors — environmental, biological, genetic risk factors that can perhaps increase the chances somebody will suffer with anxiety.

Dr. Timothy Zeiger – Sure. I think if we break it down we can look at it in three perspectives — bio, psycho, social. So from a biological perspective, we know that there are chemicals in our brain and if they’re not regulated or if they’re not functioning at the proper level, that can create anxiety disorders. From an environmental perspective, again, things like spiders, heights, certain situations — they can be triggers for anxiety. And then thirdly, just looking at it from like a cognitive perspective, the way someone interprets a situation or their environment, the way they’re kind of thinking about situations, that can also be a trigger for anxiety.

Scott Gilbert  – So just as there are different triggers, I’m sure there are different treatments. So walk us through some of the different options there and how you may arrive at each. For example, whether to take an approach that involves therapy or maybe medication is right for someone.

Dr. Timothy Zeiger – Sure. I’d say our practice here at Penn State is to, you know, look at every individual, every case, you know individually and kind of break it apart and really kind of try to understand it. I think our first line of approach would be therapy and then medication would be a second line intervention, or a combination of both. Again, looking at how it’s really impacting the person’s quality of life and day-to-day functioning. So someone who’s very impaired would probably benefit from both the medication and the therapy to help them kind of overcome their anxiety and get back to optimal functioning.

Scott Gilbert  – Probably no one size fits all approach, obviously.

Dr. Timothy Zeiger – Unfortunately not. It’s not like, you know, you’ve got a bacterial infection or a viral infection and you go to your primary care doctor and they prescribe a ten day treatment or no treatment at all. You know, anxiety and treatment of anxiety is very individualized.

Scott Gilbert  – And how much of a product of the fact that is that that there are so many different types, like we talked about? I mean, if somebody comes to you with panic disorder, perhaps a different course of treatment is in order from social anxiety.

Dr. Timothy Zeiger – Yes. So someone walking into the clinic for the first time, we’re going to give them a very thorough assessment, do a very detailed history, family history. We’re going to look at pretty much every aspect of their life, really to try to understand what’s going on. And from that, you know, discuss with them the best course of treatment.

Scott Gilbert  – And so let’s go back a little bit to prevention because, you know, are there steps that people can take — for example, eating well, exercising? We hear that there are many reasons to do that. Do those factor in here as well?

Dr. Timothy Zeiger – Very much. I think sleep is a very big component, to just emotional health and wellbeing in general. Often we find that people who are sleep deprived, it really just intensifies their behavioral health condition, especially anxiety. So sleep hygiene is a very kind of critical component. Diet is also a critical component along with exercise.

Scott Gilbert  – And when we hear about diet, that means all the typical things we know about? Eating a balanced diet and lots of leafy greens?

Dr. Timothy Zeiger – Yes. Absolutely. You know, we want to avoid things like caffeine, stimulants, chocolate, kind of anything like that that could trigger kind of the nervous system and kind of activate it more, making the anxiety symptoms even more debilitating.

Scott Gilbert  – I was going to ask you about caffeine because some people may feel like they need caffeine in order to function. I’d be lying if I didn’t say I had a cup or two or three of coffee each day. On the flip side, there are also people who may feel like if they’re anxious, alcohol or some substances like that, or something to turn to to calm their nerves. Is that a dangerous thing to consider?

Dr. Timothy Zeiger – Yes, it absolutely is. You know, with caffeine we just kind of educate people on the cost, kind of benefit. You know, caffeine versus not using caffeine. Oftentimes, unfortunately, we see what we call kind of comorbidities between behavioral health issues such as anxiety and the use of substances — like alcohol is a very big one. Something that kind of calms the nervous system. It’s a depressant and kind of once that effect wears off, the anxiety can really roar its ugly head and come back.

Scott Gilbert  – This is Ask Us Anything About Anxiety from Penn State Health. I’m Scott Gilbert. This is Dr. Timothy Zeiger. He’s a psychologist and he welcomes your questions. Just add them to the comment field of this video, whether you’re watching it live or on playback as so many people do. And we appreciate you watching today. I’d like to ask you, Dr. Zeiger, about how anxiety is connected to some other disorders we hear about pretty commonly, for example, OCD, or obsessive compulsive disorder.

Dr. Timothy Zeiger – Yes, absolutely. So if we think of anxiety disorder, so anxiety is what I would call the general umbrella. And then things like obsessive compulsive disorder, they fall under the umbrella along with your phobias and some of the other anxieties that we’ve talked about.

Scott Gilbert  – And so a lot of different ways it can go, then. PTSD — does that fall in there? Post traumatic stress disorder?

Dr. Timothy Zeiger – It does, yes. That’s under the umbrella of anxiety disorder.

Scott Gilbert  – You talked a little bit about this earlier, but can you tell me a bit more about how symptoms related to anxiety can actually manifest physically? Some of the issues you see in your patients when they come in?

Dr. Timothy Zeiger – Sure. I think that’s probably one of the things that, symptoms that first kind of trigger someone to think that they might have an underlying issue with anxiety. So if we look at it developmentally, you know, with our youngest patients we see things like, you know, stomachaches or headaches or, you know. With some of our older population, just kind of general fatigue and unexplained pains, and those are very common kind of frequent physical symptoms that we see.

Scott Gilbert  – It’s the mind-body connection. Do you think a lot of people may not realize just how much the mind and body are connected?

Dr. Timothy Zeiger – Yes, I see that every day in my practice. You know, I say that thing on your shoulder controls the rest of your body, and they kind of stop and think for a second and they’re like, oh yeah you’re right. So, you know, again, that education piece is pretty important for people.

Scott Gilbert  – So again, you know, people watching this video may have some questions. They may be thinking, OK, some of the symptoms I’ve experienced seem pretty average, everyday. Some others may be looking for that next step. They may be wanting to look into whether they might have a type of anxiety disorder. What advice can you give them?

Dr. Timothy Zeiger – Yeah, absolutely. I would say the first thing is not to hesitate or fear seeking out an evaluation or treatment. I think there’s less of a stigma now — although it still exists — with behavioral health and people seeking treatment. But I think, you know, a kind of first line of intervention would be to talk to your child’s pediatrician if we’re talking about a pediatric patient. Or if we’re talking about an adult patient, with their primary care doctor, as they probably have a really good, established kind of relationship with that person already. And that might help ease some of the angst about seeking treatment.

Scott Gilbert  – And should people want to contact the Outpatient Psychiatry Clinic here at Penn State Health, the number to call for that is 717-531-8338. Again, that’s 717-531-8338 for the Outpatient Psychiatry Clinic here at Penn State Health. And we’re going to put that number as part of the Facebook feed. Mike’s doing that right now for you. So anything else as we wrap up here, Dr. Zeiger? Any parting advice or closing words here?

Dr. Timothy Zeiger – No, I would just say that I think the prevalence of anxiety disorders are very high and don’t fear seeking out treatment.

Scott Gilbert  – I’m glad you brought that up because I read somewhere about three million Americans each year are diagnosed, something along those lines.

Dr. Timothy Zeiger – Yes. The rates are very high. They might even be higher, as a lot of people don’t seek out treatment, again for kind of the fear behind it or the stigma behind receiving treatment.

Scott Gilbert  – We’re providing the resources with this video in the links we provide for you to get more information. We hope you found it useful and we thank you, Dr. Zeiger, for your time today. And I thank you for watching Ask Us Anything About Anxiety from Penn State Health.

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