Anxiety disorders tend to first show up in childhood – maybe in elementary school you noticed that you really, unusually, dreaded giving a book report or answering questions in class – these can be symptoms of an anxiety disorder. Anxiety disorders tend to come and go throughout your life particularly at times of significant life transition. Now this can be at times a challenge when you lose a loved one, when you lose a job, but interestingly anxiety disorders can also be triggered by positive transitions: when you get married, when you have your first child, when you get a promotion at work. So any significant change in your life or lifestyle can trigger an anxiety disorder especially before it’s been treated. Some people who suffer from an anxiety disorder also experience panic attacks. A panic attack is an especially acute bout of anxiety. It tends to come on very suddenly and can last from a few minutes to typically about 30 minutes. It’s a very uncomfortable episode. During a panic attack you’re likely to feel that your heart is racing, you make feel that your thoughts are racing, you may feel that you’re speaking without making sense. Sometimes they are severe enough for individuals will worry that they’re going to faint or have a heart attack. They may call themselves into the ER. They may fear they’re going to die and they fear that they’re going to lose their rational mind. These are all common symptoms of a panic attack which can be very uncomfortable. One of the most frustrating symptoms of an anxiety disorder is something that we call anticipatory dread. This works as follows: suppose you’re called upon to give a presentation in a business meeting but you get very nervous, you feel paralyzed with anxiety, maybe you even have a full blown panic attack. Unfortunately that experience creates a clear memory, a negative memory, so even if you know that you have a business meeting, a presentation coming up six weeks in advance, you may already start to anticipate that, you may already start to dread that well in advance so you may find two weeks before this business meeting that you’re losing sleep, that you’re already working about it, you’re obsessing about it. So part of what we have to work with in treating an anxiety disorder is lessen this anticipatory dread and teaching the client to be more in the here and now not creating problems for themselves in the future.