Generalized Anxiety Disorder

Dr. Steven Pence is an anxiety specialist in the treatment of generalized anxiety disorder for both children and adults. Dr. Pence's office is located in Oakland County, Michigan in Bloomfield Hills. Dr. Pence treats generalized anxiety disorder with evidenced-based cognitive behavior therapy with emphasis on exposure response prevention (ERP) for both weekly therapy and intensive outpatient treatment programs. Generalized anxiety disorder (GAD) is characterized by chronic anxiety, constant worry and tension, even when their is little or nothing to provoke it. They can not seem to forget their concerns and it can interfere with their daily functioning. People with GAD startle easy, have trouble sleeping, have heart palpitations, tremors, chest pain, or dizziness. The National Institute of Mental Health estimates that 3.1% of adults in the U.S. have met the diagnostic criteria for GAD within the last year. 

Symptoms of this disorder may include:
-Muscle tension and aches
-Difficulty swallowing
-Trembling or twitching
-Sweating, palpitations, or hot flashes
-Difficulty concentrating or controlling worry
-Excess anxiety that is disproportionate 
-Sleep disturbance
-Depression and substance abuse may occur with an anxiety disorder

Possible Causes and Risk Factors:

-Brain Chemistry

-Genetic Background

-Gender (twice as common in women)

-History of Trauma

-Physical Illness


-Substance Abuse

Cognitive-behavioral therapy involves education, monitoring, physical control strategies, cognitive control strategies, and behavioral strategies. It is recommended to have full blood work up and physicals to address any underlying issues such as Thyroid disease, Atrial Tachycardia, Addison's, Cushing's Disease, Diabetes Mellitus, or Hypoglycemia. It is essential that clinicians understand differentiating anxiety associated with medical illnesses from primary anxiety diseases. This includes comprehensive assessment such as are the onset of symptoms temporally related? Do anxiety symptoms disappear when the primary medical condition is treated? The clinician should also judge whether the disturbances that are present may be better accounted for by the presence of a primary anxiety disorder, a substance induced anxiety disorder, or an adjustment disorder brought on by the diagnosis of a primary medical condition.

Test Anxiety, a type of performance anxiety 
When considering treatment for test-taking anxiety, make sure that you have a comprehensive diagnostic assessment to rule out other possible causes of your symptoms.  Not all cases of test anxiety are alike, and sometimes symptoms of test anxiety actually reflect a separate, underlying condition.

Fear of failure. While the pressure to perform can act as a motivator, it can also be devastating to individuals who tie their self-worth to the outcome of a test.

Lack of preparation. Waiting until the last minute or not studying at all can leave individuals feeling anxious and overwhelmed.

Poor test history. Previous problems or bad experiences with test-taking can lead to a negative mindset and influence performance on future tests.

Physical symptoms: Headache, nausea, diarrhea, excessive sweating, shortness of breath, rapid heartbeat, light-headedness and feeling faint can all occur. Test anxiety can lead to a panic attack, which is the abrupt onset of intense fear or discomfort in which individuals may feel like they are unable to breathe or having a heart attack.

Emotional symptoms: Feelings of anger, fear, helplessness and disappointment are common emotional responses to test anxiety.

Behavioral/Cognitive symptoms: Difficulty concentrating, thinking negatively and comparing yourself to others are common symptoms of test anxiety.

Don’t assume that just because you have test anxiety that the problem is only test anxiety. Test performance issues may also have an independent panic component. If the panic component is ignored or left unaddressed, treatment is likely to fail.

The very characteristics that make some individuals successful can serve as liabilities for others. Characteristics like perfectionism and other obsessive-compulsive traits can be associated with pathological doubt, which can induce panic attacks, increase test-taking time, and lead to procrastination and avoidance of essential test preparation. If this is the case, the most effective treatment would address these characteristics, not the test anxiety itself.

The most evidence-based treatment for the above issues (test anxiety, panic, OCD traits) is cognitive behavioral therapy (CBT). CBT can also address any related depressive symptoms. 

In addition to psychotherapy, some medications can be helpful (e.g., SSRIs, etc) but it can take awhile for these medications to build up to therapeutic levels.