[music plays] [no dialogue] >>Lori Banks: Coming up next on Being Well, we'll learn more about anxiety disorders with our guest Dr. Susan Longley.

Anxiety is one of the most treatable mood disorders, and it affects women more than men.

It's estimated that 28% of Americans will experience an anxiety disorder in their lifetime.

We'll learn more about the nature of the disorder, as well as symptoms and treatments choices available.

That's all coming up next, so don't go away.

[music plays] Production of Being Well is made possible in part by: Sarah Bush Lincoln Health System, supporting healthy lifestyles.

Eating a heart healthy diet, staying active, managing stress, and regular checkups are ways of reducing your health risks.

Proper health is important to all at Sarah Bush Lincoln Health System.

Information available at sarahbush.org.

Dr. Ruben Boyajian, located at 904 Medical Park Drive in Effingham, specializing in breast care, surgical oncology, as well as general and laparoscopic surgery.

More information online, or at 347-2255.

>>Singing Voices: Rediscover Paris.

>>Lori Banks: Our patient care and investments in medical technology show our ongoing commitment to the communities of East Central Illinois.

Paris Community Hospital Family Medical Center.

HSHS St. Anthony's Memorial Hospital, delivering healthcare close to home.

From advanced surgical techniques and testing, to convenient care for your family, HSHS St. Anthony's makes a difference each and every day.

St. Anthony's, where you come first.

Welcome back to Being Well.

I'm your host, Lori Banks.

And today we're talking about anxiety.

And Dr. Susan Longley has joined us again.

She's an assistant professor in the Department of Psychology here at Eastern, and also a licensed clinical psychologist, correct?

>>Dr.

Susan Longley: Yes, great to be here.

>>Lori Banks: Thank you for coming back.

The last time we had you on, you did a great job of explaining depression.

And so often we hear depression and anxiety together, that we wanted to focus on just anxiety today.

So, to get the conversation started, tell us in general terms what exactly is anxiety.

>>Dr.

Susan Longley: Well you know what, when we're talking about anxiety disorders, we're talking about two normal emotions that have kind of gone awry.

So, we're talking about fear, which is being afraid, having physical reactions to something that's an immediate threat, okay?

And it's very adaptive because if you have something that's attacking you, your body immediately goes into action.

The animal that waited was the animal that died, okay?

>>Lori Banks: So it's, yes, so it's a fight or flight kind of thing.

>>Dr.

Susan Longley: And anxiety is really more in the future.

It's apprehension about the future.

But it's also useful because it keeps you sharp, it keeps you vigilant.

And a little bit of anxiety they found really enhances your performance, okay?

But when we're talking about anxiety disorders, we're talking about something that has to last six months or more, and it's way out of proportion to whatever you fear or worry about it, and it interferes with her life.

You know, it causes people a lot of distress, to the point where they can't function well at work, at school, you know, in social arenas.

So, it's that anxiety and fear that we normally have, that's kind of amped up, you know, to a point where people really can't function very well.

>>Lori Banks: So, it's the opposite of depression, where you know, depression was it's more than just the blues.

It's something that really affects your life.

Anxiety is kind of on the other end of things, where you're tense and you're up, and also affecting life.

So, it's more than just being generally nervous or anxious about an upcoming event.

>>Dr.

Susan Longley: No, and that's normal to do that.

It's being afraid or worried about all kinds of things that don't warrant that, and for months.

You know, it has to be six months or more.

>>Lori Banks: So, what type-- Anxiety, we look at it like an umbrella.

So, anxiety's at the top, and then there are several mood disorders that fall under the term of anxiety.

Can you kind of tell us about what they are?

>>Dr.

Susan Longley: Well I think you mean anxiety disorders, and here they are.

There are four of them for adults, and that's what I'm going to really focus on.

Generalized anxiety disorder, and we call it GAD, social anxiety disorder, we call that SAD.

There are specific phobias, and then there's also panic disorder, as well.

>>Lori Banks: Okay, which of those four is the most common?

>>Dr.

Susan Longley: The one that's most common are the phobias, the specific phobias.

>>Lori Banks: So, like fear of water, flying, maybe fear of dogs or spiders, snakes.

>>Dr.

Susan Longley: Yeah, those are all the big ones.

That's about 9% of people.

>>Lori Banks: Okay, so why don't you run us through kind of some descriptions of each of those four and some of the symptoms, so we can kind of identify what's the difference between them.

>>Dr.

Susan Longley: Okay, first I'll give you a sort of little bite about how to remember each one.

So, GAD is really worry, worry, worry.

That's really what makes GAD different.

The rest of them, like panic disorders, it's really fear, and it's the symptoms of fear.

So, we call it fear of fear.

And what it is, is there's something called the fight or flight syndrome, and it's something that kicks in automatically when you have something that's threatening you.

Except in panic disorder, these symptoms kick in unexpectedly, and really not to anything that you might normally be afraid of.

And I don't know... Social anxiety, that's when you are afraid of performance or social situations.

And what you're really afraid of is that you're going to make a food of yourself, you know, that you're going to embarrass or you're going to humiliate yourself, and that people will be watching you and that they'll be judging you.

And the phobias, you know, those are fear of specific things, like we just talked about.

>>Lori Banks: So, these go then beyond.

I mean, we all probably, I mean I have a fear of, I get nervous when I have to speak in public.

But I can still do it.

So, like social anxiety, that goes beyond just those butterflies that kind of go away once you get into the situation.

>>Dr.

Susan Longley: That's right because most people with social anxiety, they'll do anything they can to avoid those situations.

And if they're forced into those situations, they'll be extremely distressed the entire time.

They never calm down.

>>Lori Banks: So, you know, actual symptoms of their pulse is elevated, maybe sweating, blood pressure gets high, just-- >>Dr.

Susan Longley: But what they have is they usually have what we call situationally focused panic attacks.

So, panic attacks are not just for panic disorder, although that focuses on it.

But those panic attacks, they're scary.

I mean, people feel like they're having heart attacks.

So, some of the things about panic attacks is that your heart rate goes up, you have shortness of breath, you have chest pains, you choke, you tremble, you sweat, you have nausea, you're dizzy, you're numb, you know, you might tingle, you have hot flashes.

There's something called depersonalization, where you feel kind of like you're viewing yourself from outside of yourself.

And there's a fear of dying or losing control.

So, you have to have four of those in order to qualify as having a panic attack.

And they have that in reaction to any kind of social or maybe performance situation.

>>Lori Banks: Okay, talk about some of the specific, we've kind of gone through some specific outward, you know, symptoms of those.

What about for generalized anxiety disorder?

>>Dr.

Susan Langley: Okay, so for generalized anxiety disorder, it is constant, excessive worry out of proportion to any kind of stress or problems that you're having in your life.

It's also very difficult for people to control it.

That worry, it keeps intruding into their thoughts.

They just can't push it out.

In fact, the more they push it out, the more prominent it becomes.

And then they have the symptoms of tension, rather than panic attacks.

They're irritable, they're restless, they have GI upset, you know, gastrointestinal upset, difficulty to sleep, difficulty concentrating.

And of course because they're spending so much mental energy on this and they're so tense, they're tired, you know?

So, that's GAD.

>>Lori Banks: So, it's kind of like your brain just never shuts off.

It never just goes blanks for a little bit.

It's always working overtime.

>>Dr.

Susan Longley: And it has to go on for six months, okay?

So, and it's usually worrying about a lot of topics, but they're usually not really big things, you know, that are really happening right now.

>>Lori Banks: Things that other people would go, eh, what's the big deal?

You are just oh my gosh, you know, this.

And probably what happens is you worry about this, which leads to this, and this, and this and this down the road.

>>Dr.

Susan Longley: One might start worrying about the way that their house looks, although they probably keep it immaculate outside.

Then they might worry about the value of their house going down in their neighborhood, although there's no reason to because it's a really great neighborhood.

And it just builds on that, you know.

>>Lori Banks: What are some of the outward symptoms then if someone has a phobia?

>>Dr.

Susan Longley: Oh, phobias.

Those are really interesting.

So, phobias are really extreme fear to either some kind of object or some kind of situation.

And it's way out of proportion to those things.

I mean yes, spiders might be kind of creepy to people, but you can escape the spiders.

You don'r really have to stick around them, and they're not going to attack you usually.

And that is they have an immediate anxiety reaction to it, often a panic attack like we talked about.

In addition to that, they might have to be around those things, but they're under so much duress when they're around the things that they're really afraid of.

And again, we have that it has to last six months or more.

And they're very distressed, and it really interferes with their life.

I know of people who are so afraid of spiders that they're stuck in a room because they're afraid there are going to be spiders in their house, you know.

>>Lori Banks: So, do phobias come from maybe, and I think of like people who are afraid of dogs.

You know, maybe they got bitten by a dog when they were little.

Do phobias stem from an actual event happening to them?

Like fear of water, maybe you almost drowned when you were a kid?

Does that all come from that, or is it kind of hard to figure out where a phobia actually comes from?

>>Dr.

Susan Longley: Well I think phobias often do come from real events because biologically, we're prepared to learn certain kinds of fears, and phobias are a really good example.

I mean, we're prepared to learn to fear things that often threaten us.

But the truth is that somebody who's phobic, they feel like they can't escape it, and they feel like they have no control.

And they have these physiological reactions to it.

And so, we're biologically prepared, evolutionary, you know, from evolution to be afraid of things and to learn fears.

And some people are more prepared to learn them than others, you know, because it's genetic.

It runs in families usually.

And they found, they're now looking at specific genes.

And they found about 17 genes, which seem to be contributing to anxiety.

So, it's complicated.

Even the genetics are kind of complicated.

>>Lori Banks: When you were on the show and you talked about depression, you kind of talked about where it actually happens in the brain and sort of what's going on.

In someone with anxiety, where is all this happening in their brain, and what's kind of going on?

>>Dr.

Susan Longley: Okay, so one of the culprits they think is an area called the limbic system, okay?

And that's what we call our mammalian brain, evolved hundreds, thousands of years ago.

And it really has to do with emotional reactions to things, and very intense, very basic emotions.

And it really controls people's fear.

And so, the amygdala also starts that fight/flight reaction.

And there are neurotransmitters.

It's usually, they think that there are three neurotransmitters.

Normally, one of them called GAD kind of puts the breaks on other neurotransmitters.

But in anxiety, anxiety disorders, it doesn't do its breaking work.

You know, there's not enough of it.

Serotonin, remember we talked about that also having a role in depression, and there's not enough of it.

Normally it regulates mood.

But if there's not enough of it, that mood is not regulated anymore.

And the last one is norepinephrine.

And norepinephrine really is what we call the stress hormone.

It is the one that kicks in and causes those physiological reactions, that fight/flight syndrome.

Except with people with anxiety, it never shuts off.

[laughing] >>Lori Banks: So, it sounds like there's no regulator, you know, or governor.

You know, if you think about a machine, there's nothing to kind of slow it down.

>>Dr.

Susan Longley: That's exactly right, yeah.

>>Lori Banks: So, how does someone ask themselves the question, I hate using the word "normal," but when might someone think, hmm, my symptoms and what's going on in my head is a little out of control, or maybe I should talk to somebody about this and see if what I'm feeling is a little not normal.

>>Dr.

Susan Longley: Well I think the two big things are what we call distress and dysfunction.

When you are so distressed by things, you can barely think.

If it causes you not to be able to work the way that you used to, and it impairs how you perform in school, and it impairs how you are in social situations, you've got a real problem.

You know, and if it has persisted for six months or more, you're diagnosable.

>>Lori Banks: So, any time it's affecting your regular life.

>>Dr.

Susan Longley: Yeah.

>>Lori Banks: You know, you can't, you don't want to go out of the house, or your reactions to situations are way out here, then it's time to do something about it.

>>Dr.

Susan Longley: It is, and if you're so tired, you know, because you're worrying so much you can't even function.

I mean, those are all things.

>>Lori Banks: So, someone kind of recognizes that okay, I need some help here.

What kind of, what's the course of treatment?

I mean, is it medication, is it therapy?

Is it a combination of both?

What really works for people with anxiety?

>>Dr.

Susan Longley: Okay, this is the great thing.

We can really treat anxiety.

And for the most part, we can treat anxiety with psychotherapy alone, okay?

They do often give medication at the beginning because people might be so distressed they can't function.

And it does help them to function more quickly.

But the things that you teach them, and usually the best form of therapy, the one that we have done studies and we know that it works very well, is what we call cognitive behavioral therapy.

And basically it teaches you new ways of thinking and new ways of behaving.

And a really important part of that CBT, there really isn't a part of depression we talked about last time is something we call exposure.

And what you do is, the idea is you need to face your fears.

And the more you face your fears, the less afraid you become.

And so, you do this gradually.

>>Lori Banks: Yeah, if you're afraid of spiders, you don't put a box of them in front of somebody.

>>Dr.

Susan Longley: Well, they've got something called flooding, where if you're brave enough to do that you can.

But it depends on what you're afraid of.

For somebody with, let's say a generalized anxiety disorder, they would make them think about the things that they are really anxious about.

With somebody with phobias, you can actually, you know, not flooding, the usual way of doing this is to have them gradually encounter closer and closer things that, the object or the situation that they're afraid of.

For something like panic disorder, you have them, you mimic the symptoms of panic disorder.

But you do it in a safe environment.

So, rather than being, you know, associating those symptoms with being afraid and being surprised, and something horrible, you associate it with safety.

And the more you expose someone, the less afraid that they become.

They become accustomed to it.

>>Lori Banks: So, when you were on talking about depression, you talked about this CBT.

So, this is kind of like a skill teaching sort of therapy?

>>Dr.

Susan Longley: Absolutely, it's kind of the idea: give a man a fish, he'll eat for a day; teach a man to fish, he'll be able to feed himself his whole lifetime.

And so, you're teaching people life skills about how to take care of themselves when they know they're having an anxiety, they're going into having, you know, anxiety attacks, and what to do when they do that.

And it's very brief.

It's about 12 to 16 weeks.

And it works for most people.

I mean, it works really well.

>>Lori Banks: So, do some people do that and have a medication?

>>Dr.

Susan Longley: They do.

And often people are prescribed medications.

Psychologists can't prescribe medications, so you have to work with either your general practitioner or your psychiatrist.

The ones that are really recommended today are, they use antidepressants, the same thing that they use for depression.

And there are also something we call anxiolytics, but they tend to be habit forming.

And we kind of look at those as old fashioned ways of dealing with it because once you start taking those, it's like you never learn the life skills that you need to be exposed to those fears and learn to deal with them.

>>Lori Banks: So, is it something that, you know, if you go through some CBT or therapy, that you can get it to go away?

Or is it something you're always going to kind of have?

>>Dr.

Susan Longley: You know, we teach people how to manage it.

If you don't ever have treatment, then you will constantly have very high clinical levels of anxiety.

If you have treatment, it doesn't mean that you will never experience anxiety again.

It just means that you know how to manage it now.

>>Lori Banks: It seems a little bit like diabetes.

Once you kind of get diabetes, you sort of have it.

But you learn to manage it.

But it never, it doesn't really ever go away.

So, this sounds like it's kind of the same thing.

You're teaching people to manage it so that they can have a full life and be able to participate in life.

Let's talk about, I'm sure there's people watching that maybe have a spouse or a friend who they, after hearing this, they think oh, I think she worries excessively.

How should someone approach a spouse or a friend about if they have this?

I think, you know, I'm thinking back to our depression.

You don't just say, "Oh, just get over it," you know.

So, how do you talk to someone who really has that excessive worry?

Because, I would think that, "Oh, just don't worry about it," that doesn't work.

>>Dr.

Susan Longley: No, and when you say that to somebody, it just makes them worry more about the way that they're worrying, you know.

So, that doesn't work.

But what does work, if you're a spouse or a friend of this person, first I'd educate myself.

I would really try to find out anxiety disorders, and maybe the kind of anxiety disorder that that person has.

And be supportive of them.

Let them talk to you about it.

Don't force them to go to treatment, but learn about treatment yourself and then make suggestions, you know.

But, and once they start treatment, be patient because it takes a while to learn how to manage your anxiety.

And you know, just be sympathetic to the person.

If you're judgmental of someone, you tell them to pull themselves up by their bootstraps or just stop worrying, that just makes the person more worried and more anxious.

>>Lori Banks: Or if someone's afraid of dogs, just go, "Look at that dog, just go over there," it's... >>Dr.

Susan Longley: You don't want to do that, no.

Don't do this at home, is what they say.

[laughing] >>Lori Banks: Don't do immersion therapy yourself, I guess.

>>Dr.

Susan Longley: That's exactly right, yeah.

>>Lori Banks: You could really wind up with a pretty bad situation.

>>Dr.

Susan Longley: You could.

>>Lori Banks: I have one more question.

We often hear about anxiety and depression going together.

Is it pretty common that if you have anxiety, you're going to have depression?

Why do they seem to go together?

>>Dr.

Susan Longley: Oh, well there's something called, and it's inheritable, called negative affectivity.

And that is really an inherited and biological based tendency to experience negative emotions, to really hone in on them, to really remember them, to really, you know, kind of turn them over in your mind over and over again.

And you know, people have it to different degrees.

You can't help it, you're born with it, you know.

And that's really one of the things we teach people to manage.

>>Lori Banks: So, it's not like manic depressive, where you're up here, down here.

But anxiety/depression, is it kind of, is an ebb and flow kind of thing.

>>Dr.

Susan Longley: It is, and that's the thing about treatment.

Only about a third of the people who have anxiety disorders get treatment.

And what you're going to have is the more, when you have a stressor or a perceived stressor in your life, you're going to start having those symptoms more intensely.

But then it might recede a little bit, but then it comes back.

And that's really what the treatment helps to do, is even out, you know, that ebb and flow of those things.

I hope you don't mind, I want to say one thing.

This is a really, really important issue because 18% of all people in the United States in any one year have anxiety disorders.

It is one of the most common mental health problems.

And 28% in their lifetime.

So, it's a big deal.

>>Lori Banks: It is.

I wanted to ask, too, about a little bit of advice here as we kind of wrap things up.

What should people do if they're seeing this, and they think, oh... Who should they see first?

Should they talk to their primary care?

Where should they go first?

>>Dr.

Susan Long: Well I have a certain bias, I have to admit.

People rarely think about going to their psychologist, you know.

>>Lori Banks: Well a lot of people don't have one, depending on where you live.

There's not a lot of psychologists/psychiatrists in rural, you know, in our area.

>>Dr.

Susan Longley: And so, I think what most people do is go to their general practitioner.

But I think they should go to their general practitioner with some knowledge, and that is say, "You know, I'm looking for someone who knows how to treat anxiety disorders.

And I've heard that cognitive behavioral therapy is really effective in treating them."

And the GP will give you a referral.

>>Lori Banks: Okay, so start with your primary care.

But again, be armed with knowledge about what you might have.

Well Susan, we're all out of time.

Thanks so much for coming on and explaining something that, as you said, a lot of people have, but then there are still a lot of people who aren't getting treatment.

And the good news for this is it's so highly treatable, unlike so many other things out there, that people can get good results.

>>Dr.

Susan Longley: Yeah, if you have a disorder, anxiety disorders are the one to have.

[laughing] I mean, if you have one.

>>Lori Banks: If you have to have one, that's the one to have.

Thanks, Susan.

We like having you on the show.

>>Dr.

Susan Longley: Hey, thank you.

I appreciate it.

>>Lori Banks: Production of Being Well is made possible in part by: Sarah Bush Lincoln Health System, supporting healthy lifestyles.

Eating a heart healthy diet, staying active, managing stress, and regular checkups are ways of reducing your health risks.

Proper health is important to all at Sarah Bush Lincoln Health System.

Information available at sarahbush.org.

Dr. Ruben Boyajian, located at 904 Medical Park Drive in Effingham, specializing in breast care, surgical oncology, as well as general and laparoscopic surgery.

More information online, or at 347-2255.

>>Singing Voices: Rediscover Paris.

>>Lori Banks: Our patient care and investments in medical technology show our ongoing commitment to the communities of East Central Illinois.

Paris Community Hospital Family Medical Center.

HSHS St. Anthony's Memorial Hospital, delivering healthcare close to home.

From advanced surgical techniques and testing, to convenient care for your family, HSHS St. Anthony's makes a difference each and every day.

St. Anthony's, where you come first.

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