Registered Marriage & Family Therapist, Registered Psychotherapist

For more information about child based anxiety issues feel free to contact Anita Pal.


Internet Resources


  • The Anxiety and Phobia Workbook. Edmund J. Bourne (1995).
  • Dying of Embarrassment: Help for Social Anxiety and Phobia. Barbara Markway et al. (1992).

Understanding Anxiety and Panic Disorders

Anxiety based disorders are one of the most common emotional problems, affecting approximately one in nine North Americans. Anxiety disorders differ from normal feelings of anxiety or nervousness in the fact that the symptoms appear to occur without apparent reason and do not go away. Symptoms of anxiety disorder may vary from person to person but usually include both physical and psychological symptoms. Anxiety disorders can take several different forms, depending on circumstances and family history.

The more common forms of anxiety disorders include generalized anxiety, panic disorder, and phobias. If left untreated, anxiety disorders can severely limit a person’s ability to function. Most individuals, exhibiting symptoms of severe anxiety, also experience other mental health issues including difficulties in relationships. General anxiety is often accompanied by at least one of the following:

  1. Panic Attacks/ Panic Disorder
  2. Phobias (most commonly fears of leaving the house or fears of social situations)
  3. Depression
  4. Substance use issues (most commonly alcohol or marijuana use as a means of coping)

Causes of anxiety disorders are often varied and multiple in nature. There can be either or both a number of psychological or medical conditions that can contribute to an anxiety disorder.

For example, some medical conditions that are known to contribute to development of anxiety disorders include hypoglycemia and hyperventilation. Other medical conditions that may increase risk of anxiety disorders include emphysema, cardiac arrhythmias, congestive heart failure, substance use withdrawal, and certain vitamin deficiencies. Symptoms from both generalized anxiety and panic attacks often mimic other medical conditions such as cardiac arrhythmias, hyperthyroidism, and certain types of epilepsy. For these reasons a thorough physical examination is recommended before concluding that symptoms are indicative of an anxiety disorder.

What Causes Anxiety Disorders?

Exposure to long term stress and/or severe trauma is the most common experience associated with development of anxiety disorders. Cumulative traumatic life events start in childhood and may include events such as surviving childhood sexual, emotional or physical abuse, parental neglect, parental alcoholism, childhood repression of anger, having a parent with anxiety disorder, death of a loved one, divorce, and family separation. Experiences in adulthood that can often trigger anxiety disorders include long term relationship difficulties including marital problems, abusive relationships, and high levels of ongoing job related stress. Exposure to violence can also be a trigger for development of an anxiety disorder. There is also some research to suggest that genetics can play a role in development of anxiety disorders.™

Symptoms of Panic Disorder

Panic disorder is a type of anxiety based disorder and exhibits a core symptom, the panic attack. Panic attacks consist of at least four of the following symptoms: ƒ

  • Racing or pounding heart ƒ
  • Chest pains ƒ
  • Dizziness ƒ
  • Nausea ƒ
  • Difficulty breathing ƒ
  • Fear of dying ƒ
  • Sense of impending doom ƒ
  • Flushes or chills ƒ
  • Sweating 
  •  Tingling or numbness in the hands ƒ
  • Dreamlike sensations or perceptual distortions ƒ
  • Fear of losing control and doing something embarrassing

(Excerpted from National Institute of Mental Health, Panic Disorder Treatment and Referral) 

Symptoms of Generalized Anxiety Excessive anxiety and worry occurring over the past six months characterize generalized anxiety disorder. In addition an individual must have experienced at least three of the following symptoms regularly over the past six months:

  1. Restlessness or feeling keyed up or on edgy
  2. Being easily fatigued
  3. Difficulty concentrating or mind going blank
  4. Irritability
  5. Muscle Tension
  6. Sleep Disturbance

Treatments that Work!

The most effective forms of treatment for anxiety disorders are cognitive-behavioural psychotherapy(CBT), or a combination of medication treatment and CBT. Medication is helpful for managing the intense and often debilitating symptoms associated with panic disorders, obsessive-compulsive anxiety disorder, or phobias. Cognitive-behavioural therapies offer individuals the opportunity to gain insight and understanding into how the anxiety disorder developed and, to alter present factors that are contributing to continuation of the anxiety. Other longer term solutions include learning to physiologically self calm through regular use of relaxation, meditative, and mindfulness based practices. Additionally, evidence suggests that family or adjunctive couple counselling is also helpful in dealing with anxiety-based problems, particularly for children.

What is Cognitive-Behavioural Psychotherapy (CBT)?

Specifically, CBT is a form of individual psychotherapy that examines patterns of thinking and behaviours that may be perpetuating feelings of anxiety and fearfulness. For example, after experiencing a panic attack, a person may begin to obsess about how to avoid more panic attacks. This may lead to trying to avoid all situations that the person associates with anxiety.

The objectives of CBT in this example would be

  • To identify events and thoughts that contributed to feelings of anxiety and subsequent panic attack
  • Examine alternative thoughts and interpretations of events that may reduce anxious feelings and therefore reduce chance of another panic attack
  • Provide opportunities to safely practice these constructive strategies to deal with stressful situations or negative thought patterns.

CBT is a short-term psychotherapy (12-15 sessions) over several months. In conjunction with CBT, mindfulness based relaxation training is also often used to help to decrease and prevent panic attacks. CBT with medication treatment appears to prevent relapse more effectively than medication treatment alone.