Daniel Zwillenberg PsyD - Anxiety and Panic Attacks

I would like to thank Maxine Taylor for her guidance throughout this process, and my friend, colleague, and mentor, Blaise Aguirre, for suggesting that I write this book. I would also like to thank everyone who read incomplete drafts and shared their honest feedback, including my father, David Zwillenberg, and mother-in-law, Lisa Schreiber.

I feel fortunate to have earned my doctorate at Yeshiva Universitys Ferkauf Graduate School of Psychology, where I had the privilege of being trained in a program directed by Dr. Abe Givner. I am grateful to the many supervisorsparticularly Drs. Alec Miller and Lata McGinnwho offered me the benefit of their expertise, as well as to my colleagues at McLean Hospitals 3East DBT Program.

I would like to express my gratitude to the many clients who have shared with me their pain and joy and have entrusted me with their most private selves.

Most importantly, I would like to express my deepest love and appreciation to my wife, Karen, who allowed me to dedicate a truly excessive amount of time to this project. I also want to thank my children, Jacob, Noah, and Emily, whose patience (and relatively good behavior) afforded me the opportunity to work on this book. To my siblings, I would like to point out that I wrote a book and you didnt. Just an observation.

Anxiety and fear are normal features of the human experience. These emotions are described in some of humanitys earliest written records, and they appear to exist across all known cultures. When anxiety and fear happen in the appropriate context and at an intensity that matches the situation, they help people escape danger or cope with an anticipated challenge. When anxiety and fear happen in the wrong context or at an inappropriately high intensity, they are no longer helpful. When this occurs repeatedly, anxiety and fear can lead to distress and dysfunction, resulting in an anxiety disorder.

Anxiety disorders, which have only existed as a widely recognized diagnostic category since 1980, are remarkably common. As a group, anxiety disorders are the most prevalent mental health conditions in the United States and across the world. According to the National Institutes of Mental Health (NIMH), 18.1 percent of American adults40 million peoplehave had an anxiety disorder over the previous 12 months. NIMH estimates that 28.8 percent of U.S. adults have an anxiety disorder at some point in their lifetimes. Most anxiety disorders start in childhood or adolescence, and when untreated, they can last for many years. Anxiety disorders generate emotional suffering and lower quality of life, and cause impairments in work, school, and social relationships.

Research on anxiety disorders has come a long way in a brief span of time. Just a few hundred years ago, there was widespread agreement that mental illness was caused by sin or demonic possession. Today, scientists are generating a steady stream of insights into the brain structures, neurotransmitters, and thought processes that are associated with fear and anxiety, as well as the genetic and environmental factors that influence the development of anxiety disorders. In 1927, there were only three papers published on the topic of anxiety in academic journals; today, thousands are published annually. A little over 100 years ago, patients with symptoms of anxiety were commonly diagnosed with the catch-all label of neurasthenia, which had little scientific basis and even less therapeutic value. Today, investigators are applying advanced statistical methods to identify subtypes of anxiety disorders and are using these data to develop more effective treatments.