Dr. Walkup discusses normal vs. pathological anxiety, therapeutic alliance with anxious patients, genetic influences on anxiety, importance of early intervention in children, benefits of CBT over benzodiazepines in treatment, and recognizing anxiety in young patients.
Anxiety disorders stem from discomfort with autonomy, fear of social situations, and catastrophizing global events.
Misdiagnoses in young adults with anxiety disorders can lead to self-injury, substance abuse, and identity disturbance.
Functional impairments from anxiety disorders manifest as avoidance behaviors hindering development, stressing early accurate diagnoses for effective treatment.
Deep dives
Understanding Anxiety and Normal vs. Pathologic Anxiety Triggers
Anxiety is described as a healthy emotion aiding in preparation for the future and coping with danger. Normal anxiety triggers are universal experiences like worrying about tests or traffic, while pathologic anxiety triggers are tied to normal developmental activities. Separation anxiety, social anxiety, and generalized anxiety stem from discomfort with age-appropriate autonomy, fear of social situations, and catastrophizing global events impacting personal life, respectively.
Distinguishing Between Anxiety, Panic, and Depression
Anxiety disorders highlight the difference between normal anxiety and pathologic anxiety triggers. Panic disorder is linked to a suffocation alarm in the brain triggering intense fear, distinct from typical anxiety, while depression involves an inescapable sense of sadness. The impact of misdiagnoses, especially in young adults with anxiety disorders, can lead to notable outcomes like self-injury, substance abuse, and identity disturbance.
Recognizing Functional Impairments and Avoidance Coping
Functional impairments resulting from anxiety disorders often manifest as avoidance behaviors, hindering social, language, and independence development. Parental accommodation and avoidance coping exacerbate identity issues and self-destructive behaviors in adolescents and young adults. Notable comorbidities like anxiety with avoidance coping patterns can be misinterpreted as ADHD, emphasizing the importance of early accurate diagnoses for effective treatment strategies.
Three Tiers of Treatment Approach
The podcast discusses a treatment approach involving three tiers for anxiety and depressive symptoms. Tier one focuses on reducing primary symptoms, while tier two addresses accumulated impairment such as social skill deficits and relationship challenges. Tier three deals with high-risk behaviors like suicidal thoughts and substance use. The speaker emphasizes the need to consider all three levels in treatment, highlighting the challenges faced in providing effective therapies for levels two and three.
Psychotherapy Strategies and Medication Use
The podcast delves into psychotherapy strategies for anxiety disorders, emphasizing exposure therapy for separation and social anxiety. Cognitive Behavioral Therapy (CBT) is recommended for addressing maladaptive self-talk and cognitive distortions. The speaker highlights the efficacy of combined treatment with medication and therapy, citing higher remission rates compared to CBT alone. Additionally, the discussion touches on the cautious use of benzodiazepines, suggesting their role in specific cases like school refusal but emphasizing the risks of addiction and dependence.
Dr. John Walkup, Chair of the Pritzker Department of Psychiatry and Behavioral Health at Ann and Robert H. Lurie Children’s Hospital of Chicago, Professor of Psychiatry at Northwestern Feinberg School of Medicine, and president-elect of the American Academy of Child and Adolescent Psychiatry, introduces us to anxiety disorders.
We discuss the phenomenon of normal, adaptive anxiety and contrast this with symptomatology that may warrant a diagnosis of an anxiety disorder. We learn to appreciate anxiety disorders from a developmental lens, discuss clinical pearls for building a therapeutic alliance with anxious patients, and explore psychotherapies for anxiety disorders. We also discuss psychopharmacological considerations for both SSRIs and benzodiazapines.
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