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survival instinct
sense of anxiety
symptoms of anxiety
anxiety disorders
central nervous system
heart palpitations
natural response
Management Of Anxiety In Family Practice
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Management Of Anxiety In Family Practice

Because the symptoms of anxiety mimic those of several medical conditions related to the heart, the family doctor is usually the first to be consulted by the patient. The trained family practice doctor has the ability to distinguish the difference between the presence of a true physiological problem and psychological distress.

Physiologically, anxiety is the function of our perception and interpretation of events that trigger the Central Nervous System (CNS) to react to fear or potential threat. Psychologically most individuals describe the presence of anxiety in terms of feeling stuck, trapped, or helpless to improve their situation.

Humanly, the immediate reaction to the perception of fear or threat is avoidance. Avoidance is a natural response related to our survival instinct to prevent physical pain or suffering. Emotionally, we avoid pain and suffering in the same way.

The pattern of avoidance contributes to an individual’s lack of awareness or potential to solve their problems by making active and productive changes in their lives. Prolonged avoidance will ultimately lead to a heightened physiological sense of anxiety as the brain responds to the unconscious awareness of potential threat. The result of increased hormone in the CNS triggers a sense of more physiological symptoms that may include chest pain, shortness of breath, dizziness, and heart palpitations.

Strategies to manage and control anxiety have been sought after historically since the first awareness of the relationship between the mind and body were identified in human behavior and functioning.

Goals of Treatment

Because anxiety is the product of the brains interpretation of the environment combined with a physiological response, treatment for Anxiety disorders often takes months if not years of insight based psychotherapy.

The primary goal of psychotherapy is designed to help the patient achieve more insight to the problems contributing to their anxiety. Secondary goals center on developing coping skills and strategies that will improve an individual’s sense of control and self direction in life.


Once it is determined that psychotherapy would be the best course of treatment to reduce symptoms, it can be beneficial to have the patient begin work immediately in solving their problems by giving them a way to assess their anxiety between appointments. This “homework” will give the patient a sense of responsibility and ownership to their ability to help themselves, and also establish that they are helping their doctor by gathering data between visits. Research in therapeutic alliance indicates that the stronger the bond between patient and doctor, the more likely symptoms will be reduced longitudinally.

Treatment methods

The following method was been developed by Dr. Joseph Marzano, a behavioral modification specialist in Austintown, Ohio. The technique was first established in his private practice, Advanced Counseling Solutions, LLC, but quickly became the standard of care in medically based family practices in Northeast Ohio. Family Practice Physicians have found that the technique is ideal for the purpose of immediate response to the presence of anxiety in the family practice environment when time is limited with the patient to fully assess and discuss the potential source of their anxiety.

4 step Model of Treatment for Anxiety and other Affective disorders (Marzano, 2003)

The 4 step method of Affective Disorder Management is designed to give the patient an immediate sense of control over their symptoms and to set the foundation for productive gains in therapy by improving the patients insight and ownership to their mental health functioning. Each step parallels the natural pattern of information processing and perceptual interpretation of environmental cues associated with anxiety, and depression.


Extreme ranges of human emotion are unavoidable. In fact, 73% of the adult population will experience moderate to severe anxiety. Of that 73%, approximately 35% will seek treatment for anxiety. When emotional ranges become persistent, they fall in the category of pathological. With professional help, a high percentage of emotional disorders can be managed and controlled without medication.

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