Anxiety and Panic

Anxiety and panic disorders are incredibly common in patients.  These disorders involve problems with fear.  Fear is a natural part of life and often helps us stay safe.  When that fear moves out of proportion in some way, we call it anxiety.  Examples of anxiety and panic include fear of driving, leaving the house, or shopping at grocery stores.  It can be very disabling for patients and keeps them from living comfortable lives.

The first experiences of anxiety can be caused by many things.  An initial panic attack may come from strange body sensations and the fear of death or illness.  Anxiety can come from traumatic experiences such as childhood trauma or the trauma of war.  This anxiety and panic stays with a person, even if the danger has disappeared.  Dr. Fehling is trained in treating both anxiety and panic with medications and psychotherapy.

Medications for improving anxiety and panic are divided into two groups.  The first group, SSRIs, are long-lasting and safe.  They provide a foundation of decreasing anxiety but take multiple weeks before a patient feels better.  The second group is the collection of meds that act quickly.  These can include benzodiazepines.  Benzodiazepines such as Xanax or Klonopin give relief faster than SSRIs but have abuse potential.  As an addiction psychiatrist, Dr. Fehling avoids prescribing benzodiazepines because he promotes long-term, not short-term, relief of anxiety.  This long-term benefit is achieved with psychotherapy for anxiety and panic.

The therapy used to treat these illnesses is called cognitive behavioral therapy (CBT).  Good CBT involves helping the patient learn relaxation skills while giving some exposure to what causes the anxiety.  For example, if a patient is fearful of the grocery store, eventually he or she needs to confront that fear.  CBT will help patients to face fears and to manage the emotions involved.