Anxiety is a necessary and universal emotion. With anxiety that originates from a real or perceived threat of danger, one experiences an increase in heart rate, blood pressure, diaphoresis, and other physical accompaniments to anxiety. At times, anxiety comes across as excessive worrying, and this leads to avoidant behavior. Hypervigilance is an excessive focusing of one’s attention on a possible danger or perceived danger.

When we think of anxiety, it is usually revolving around a problem or threat in the future.  Fear, on the other hand, can be a very intense emotional reaction to a danger or threat that is in the present.  We react to immediate dangers with the “fight-or-flight” response.  Fear and anxiety, to some extent, are crucial for our existence.  Fear allows us to escape from imminent threats; anxiety allows us to prepare for future problems.  Anxiety, at least in low or moderate amounts, helps motivate many people to achieve.  When someone crosses from moderate to high anxiety, it usually will interfere with the ability to perform.  The triggers for fear and anxiety may be internal or external.  With internal triggers, one may have panic attacks that accelerate, feeding on themselves, in part because the associated tachycardia can convey the message that a serious physical problem is imminent. External triggers involve situations that may trigger phobias, or severe anxiety.  These may include social situations, crowded or closed-in spaces, tests or other performances,etc. This leads to avoidant behavior, as anxious patients will tend to avoid these situations.

Pharmacotherapy is important in treating anxiety, but it is by no means the only treatment.  For those with severe pain and psychological comorbidities, “it takes a village” to treat a patient, and we get these other villagers involved. They may include psychotherapists, yoga or Pilates instructors, biofeedback specialists, etc.

Taking medicine alone is considered passive coping and is not sufficient for those with severe anxiety.  People are best off when they exercise regularly, and learn relaxation, whether they are based in yoga, Pilates, tai chi, deep breathing, biofeedback, or meditation.  We need to promote this “active coping” as a vital component of treating chronic pain and anxiety.  The addition of psychotherapy, primarily cognitive/behavioral, is also important.  It is vital to locate an excellent therapist, and for the patient to stick with that therapist for at least four to six months.  While short-term therapy is better than no therapy, we believe that the ideal time frame is one or more years.  It takes some time to integrate the ideas of therapy into our lives.  Self-help books, while somewhat useful, do not replace a great therapist; neither does talking to a close friend or relative.  A great therapist can be life-changing…..

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