A few years ago, I experienced a very intense out-of-the-blue panic attack while out for a walk with my wife. I was convinced I was having a heart problem and dying. We went to the ER where they ran some tests that ruled out a heart issue. When discharged, I was given no explanation or even theories as to what happened to me, but was told to see my primary care physician. I did, and he didn’t have a clue either. My first correct diagnosis came from a Facebook friend who read my post telling my story, which I confirmed using WebMD. Since then one therapist told me I have GAD, and another panic disorder (I think they’re both right). I use Ativan as needed. I once tried Zoloft but it gave me a paradoxical reaction and I haven’t taken one since. While there are times when I can point to a specific trigger that sets me off, there are many other occasions when I experience “free-floating anxiety” which I can’t explain. I have read that CBT can be helpful in treating GAD, but I don’t see how identifying faulty patterns of thinking can help when there doesn’t seem to be any rhyme or reason for the anxiety in the first place. I recently saw a therapist for CBT who believes there is always a trigger for anxiety, even though it may not seem like it. Is free-floating anxiety real, what causes it, and can CBT help? Thank you very much.
A: We are not always sure exactly what causes many psychological disorders, but it doesn’t make them any less real. It’s generally thought to be a combination of family history (genetic predisposition) and life experiences. Anxiety disorders are quite common but are also very treatable. Sometimes the triggers can be identified and sometimes the anxiety attacks can truly come “out of the blue.” I’ve had many clients who wake up from a deep sleep experiencing an anxiety attack. In that situation, one would be hard pressed to identify a trigger. So yes, free floating anxiety is real and panic attacks can come without obvious triggers.
It sounds like you are doing all the right things by seeking treatment, both with therapy and medication. Cognitive Behavioral Therapy (CBT) is a very effective treatment for anxiety and depression. Generally speaking, our thoughts always precede emotion and behavior, so if we intervene at the earliest possible point in the cycle, we have a much better chance of getting symptom relief. The other thing to keep in mind is that we have thousands of automatic thoughts going through our minds all day long. So many that we aren’t always aware of what we are actually thinking about. Increasing this awareness, slowing the thoughts down and replacing negative thoughts with positive ones can really make some deep changes in how we feel.
When treating anxiety disorders, I also teach clients about the fight or flight phenomenon, deep breathing techniques and lots of relaxation techniques. Having an assortment of coping skills makes a huge difference in managing anxiety symptoms when they pop up. There are many self-help workbooks available that give good explanations of these coping strategies. Many clients also benefit from taking yoga or meditation classes.
I’d suggest sticking with the therapy for several months, as well as supplementing your treatment with the adjunct techniques I mentioned above. I hope you feel better soon.
All the best,
Dr. Holly Counts
