Treatment Resistant Anxiety

Treatment Resistant Anxiety
Treatment Resistant Anxiety

Therapy for Anxiety & Treatment Resistant Anxiety in Annapolis, MD

Many people deal with anxiety at different times in their lives. Sometimes, anxiety that’s untreated can linger for a long time or become what’s known as “treatment resistant anxiety”. I help clients with all facets of anxiety so they learn how to manage their emotional response to stress, worry, and trauma from a healthier place.

Below are some important details about anxiety and how it can show up in your life. If you know you’re ready to get started in therapy with me, I am accepting clients now and would be happy to speak with you about working together.

What Is Anxiety?

Anxiety is related to your natural fear response. It is your body’s response to a threat or danger. The fear response is hardwired in all of us by way of the central nervous system.

The central nervous system has two main branches: Central and Peripheral. The peripheral is further divided into two branches: the Somatic and the Autonomic. The Somatic controls are voluntary muscles to run and fight for example. The Autonomic controls are involuntary smooth muscles that control our breathing, heart rate, and other important functions.

The Autonomic is further divided into the sympathetic and parasympathetic branches. While there is some input from the somatic branch, the fight-flight-freeze response is mostly regulated by the sympathetic and parasympathetic, with each branch responsible for different aspects of our fear response.

Understanding Anxiety

Imagine being at a campsite in the wilderness and a bold black bear approached.

You see the bear as a threat.

Naturally, your body begins the first of three responses that are triggered when you’re afraid: fight, flight or freeze.

In the past, you were told to stand tall and make loud noises; bang on pots and pans and get big to scare the bear away.

As you do this, you have healthy tension, and understandably your breathing gets heavier and your heartbeat increases.

This is an example of the fight response.

But, what if the bear is un-phased and continues to wander into your campsite?

In the past, you also read that you should not run or stare him in the eyes. You should speak softly and walk slowly to a safe place watching from a distance until he leaves. As you do this, you become even more tense; your breathing becomes more rapid, and your heart beats faster.

This is the flight response.

Treatment Resistant Anxiety

From afar you see the bear rummaging through your campsite. Eventually, he leaves and starts walking down the trail and you think, “Great he is leaving.” But, suddenly he turns toward the hill you are on and heads your way. At that point, you feel dizzy and your vision becomes blurry.

This is the beginning of the freeze response.

Understanding The Freeze Response

The freeze response is automatic and unconscious, and not something within your control. In fact, none of the fear responses are fully within your control.

During the freeze response, your body is taking your best interest by making you shut down and be still. Why? Because it thinks you have no way out and by shutting down you increase your survival.

Let’s take the example of a lion chasing a gazelle.

She catches the gazelle and clasps it by the neck and it goes limp. She drops the gazelle on the ground in front of her cubs to feed. The lioness turns away for a few moments and boom the gazelle jumps up and flees. By going limp and shutting down the freeze response prevents the lion from continuing to attack, possibly killing the gazelle.

As mammals, humans have the same fear system.

As you can see, fear can span from being very uncomfortable to downright terrifying. Not a good thing? Perhaps once you realize it helped you survive. In that sense, fear is a good thing.

What Is An Anxiety Disorder?

The fear response becomes a problem in our daily lives when it is not in response to a real threat, but a perceived one, and is experienced excessively. An overactive fear response system can lead to an anxiety disorder.

Although fear and anxiety are often used interchangeably, they are different. 

Fear is a response to a real danger. 

Anxiety is in response to a perceived danger.

Let me explain. The bear was a real threat in the present moment outside of you. Anxiety that can lead to emotional suffering is due to a perceived threat related to what is inside of you. When we have an anxiety disorder we experience life as if the bear is always around, so to speak.

So what are we exactly so afraid of?

That is a great question! Anxiety disorders are caused by a mixture of two things – nature and nurture. We can be born with certain genetic traits that make us vulnerable to having problematic anxiety.

We can also have traumatic life experiences, often as children, that can trigger or express those traits to produce problematic anxiety. The weight of each – nature and nurture – varies from person to person.

Given that we can’t change our genetic traits, we now turn to the nurture aspect of things – our traumatic experiences.

When we are children we can have adverse experiences that lead to a fear response.

Examples would be physical, sexual, and verbal abuse as well as neglect extreme insecurity, and loss.

A landmark study in 1998 conducted by Kaiser and NIH provides strong evidence about the relationship between adverse childhood experiences (ACE) and health and mental health problems as adults.

When these adverse experiences (traumatic events) happen to us to no fault of our own, we develop protection mechanisms (often referred to as defense mechanisms) to deal with the fear.

Who can blame you?

These fears are caused by problems in human relationships (not bears coming at us). To the body, it does not matter. As children, we are a bundle of emotions with poorly developed brains responsible for reasoning, judgment, and insight (executive functioning). We don’t make sense of what is happening to us, but the body knows.

These responses to early adverse experiences can be logged into the body, never get resolved, and can continue throughout the lifespan. In a sense, we can find ourselves having terrible anxiety due to a fear that is no longer around. It is perceived fear – it is anxiety.

When this anxiety impacts your life in ways that it becomes hard to function the result is an anxiety disorder.

There are several types of anxiety disorders characterized by excessive worry, intrusive thoughts, restlessness, feeling keyed up, difficulty concentrating and focusing, trouble sleeping, and body changes such as muscle tension, heart palpitations, sweating, and fatigue.

What Is Treatment Resistant Anxiety?

The standard treatments for anxiety disorders are talk therapy, medications, or a combination of both. Unfortunately, some people who have put great time and effort into both continue to struggle in a significant way.

Treatment resistant anxiety can be loosely defined as a condition in which a person has been on repeated trials of medications and/or years of talk therapy and continues to struggle in a significant way. If you are one of these people, you know how discouraging it can feel.

For the most part, TRA has not been well studied. As a result, what leads to it is not completely understood. A variety of factors may be at play. It is important to treat each case uniquely to better understand what is not working for that person.

For example, some people may simply be on the wrong medications. This could be due to poorly delivered medication management. It could also be due to a doctor not understanding your situation well enough. It is not uncommon to hear a patient complain about their doctor not listening to them.

Sometimes, for one reason or another, the patient does not take the medication as prescribed. There can be strong resistance due to the stigma of medications and/or difficulty wanting not to disappoint your doctor. A good psychiatrist can deal with these resistances well.

In fact, some research suggests that the relationship between doctor and patient is correlated to positive response to medications. Fascinating isn’t it?

Getting To The Root Of Your Anxiety

Many clients come to my office with many years of prior therapy and continue to suffer from anxiety. These therapy experiences may have failed due to a variety of reasons: inexperienced and poorly trained therapists, therapy that does not put enough emphasis on emotion and experience, and therapy where there is a poor fit between what you have and what they can reasonably provide (etc. going to a general counselor for trauma work).

The reasons could go on and on. Despite this reason, untreated anxiety can be a real problem. It is important to get a thorough evaluation that considers the variety of factors that may have led to your problems. It also requires this professional to communicate well with other health professionals.

Treatment Resistant Anxiety: Frequently Asked Questions

It is important to understand that no two people experience anxiety the same way for the same reasons. Although individuals diagnosed with the same anxiety disorder can have the same symptoms, what actually drives the anxiety and how they experience these symptoms can vary significantly from person to person.

If you find yourself having been on repeated trials of medications and have been in and out of therapy for years, I believe I can help.

Get In Touch With Me

If you’re ready for this kind of support, I would welcome the opportunity to work with you. My services are cash-based and I am accepting clients now.

My office is in Annapolis, MD and you can reach me for a consultation by calling (410) 562-9647 or sending me an email at