Anxiety – More Than Just a Case of Nerves

Until a few days ago, I’d never heard of the Center for Gender Equity and National Center of Excellence in Women’s Health. That’s when I viewed the program “Anxiety Disorders: More Than a Case of Nerves”. The keynote speaker was Ellen Haller, M.D., Professor Director of the WomenCare Mental Health Program in the UCSF’s Department of Psychiatry.

Dr. Haller does a fine job contrasting anxiety disorders against non-pathological anxiety which developed as an evolutionary adaptation to danger. “Anxiety disorders” she tells us, “are the most common disorder encountered in medicine.” Citing 31% of all women and 19% of all men as reporting having had an anxiety-related psychological event at some point during their lives. These include, but are not limited to panic disorders, phobias, obsessive-compulsive disorder, generalized anxiety disorder and post-traumatic stress disorder.

Commenting on various treatment modalities, Dr. Haller spends a good amount of time explaining Cognitive Behavioral Therapy, i.e., teaching people how to relax, and also detailing cognitive restructuring-teaching which teaches people new ways to approach old fears. She touches on the usual pharmacological players, e.g., antidepressants, anti-anxiety, beta-blockers, selective serotonin-reuptake inhibitors pointing out the most current trade names. She balanced the scales by also discussing other pharmacology-free treatment options. I was most impressed with Dr. Haller’s numerous case presentations. In my opinion these were the strongest elements of the presentation. Moving through each category of anxiety disorder, she narrated the case of a hypothetical patient, detailing how the disorder may manifest in their daily lives. Further, she even leans on popular culture reference to get the message across, for instance referencing the actor Jack Nicholson’s character in the movie “As Good As it Gets” as classic example of a patient with an obsessive compulsive disorder.

Dr. Haller’s biopsychosocial sensitivities were evident after her formal narrative, when she entertained questions from the audience. Audience members queried her on topics like how anxiety might be related to the attack on New York’s World Trade Center, menstrual cycles and birth control pills. I most appreciated Dr. Haller’s implication that the neuroanatomical correlates of these conditions were a subject of great debate and research and that we would soon see them leave the laboratory and enter the clinical realm.

KEEP THINKING!