Understanding the Restless Mind
Dr. Michael E. Portman is a clinical psychologist with an expertise in cognitive-behavioral therapy (CBT) and is an international authority on generalized anxiety disorder (GAD).
Dr. Portman has worked for over twenty years in diverse settings, from community mental health services to treating military personnel at the Cleveland Veterans Administration. He has served as an adjunct faculty member at Case Western Reserve University, Cleveland State University, and The Ohio State University, supervising advanced students. He also conducts research and trains others in the field.
Dr. Portman has authored Generalized Anxiety Disorder Across the Lifespan: An Integrative Approach published by Springer-Science and was a guest editor for a special edition of Psychiatric Annals on GAD and the lead expert author of a chapter for the Elsevier publishing company (also on GAD).
Dr. Portman currently resides in Jerusalem where he maintains a private practice treating children, adolescents, adults and couples.
What is Generalized Anxiety Disorder (GAD) and who does it affect? Is there a genetic component?
Generalized Anxiety Disorder is a mental health condition characterized by persistent anxiety and/or worry lasting for no less than six months, more days than not, around numerous activities and events. Other symptoms include: being keyed up (restless), sleep disturbance, difficulty concentrating, muscle tension, fatigue, and irritability. GAD affects individuals of all ages and cultural backgrounds. A confluence of factors contribute to the onset of GAD and genetics, based on the research, plays a 30% role.
How is GAD differentiated from other anxiety disorders such as social anxiety disorder, obsessive-compulsive disorder, etc.?
GAD is more diffuse, in nature, than the other anxiety disorders. The worry is about “everything and nothing.” This does not preclude the fact that GAD sufferers do have relational/social worries like in social anxiety disorder and obsessional thinking found in obsessive-compulsive disorder. Plus, individuals with GAD have typically experienced many stressors common to individuals struggling with post-traumatic stress disorder. They may also experience panic-like symptoms unique to panic disorder. However, in GAD more global worry and anxiety is the hallmark of the condition. Having said that, GAD often coexists with at least one other mental health disorder in 90% of cases. It has been called the “co-morbid” anxiety disorder.
Can GAD cause somatic (physical) symptoms or conditions and how does this affect the diagnosis and treatment of the patient?
GAD can cause a host of somatic symptoms that can include back or neck pain, gastrointestinal distress, chest pain, rapid pulse, shortness of breath, frequent urination, dizziness, tension headaches, etc. Medical illnesses often co-occur with GAD, such as irritable bowel syndrome (IBS), hypertension, and Acid Reflux Disease (GERD). Physicians should work with mental health professionals to try to work out whether GAD is contributing to the physical symptoms and illnesses or not. Often when GAD is properly diagnosed and treated many somatic symptoms and illnesses abate or are much less intense and disabling.
At what age do symptoms of GAD typically appear?
GAD can appear at any age. The most common age of onset is in the late teens and in midlife. It is estimated that GAD afflicts around 5-7% of the general population. The symptoms build steadily over time and are often not diagnosed and treated effectively until many years after they first appear.
Everyone has some anxiety at times, at what point does it need to be treated? How would a parent know when their child needs help?
Anxiety has been with us since time immemorial and most individuals experience anxiety and worry at some point in their life. However, when anxiety and/or worry is intense, persistent, and impairs functioning in broad areas of life, treatment is indicated at any age across the lifespan. In regard to children, anxiety, and GAD in particular, presents with more bodily symptoms such as headaches and stomachaches. And, worries in children with GAD are often about school performance, safety of self/others, health, disasters, war, and friends or classmates.
What are the main modalities of treatment for GAD?
Cognitive-behavioral therapy (CBT) with or without medication(s) is the main treatments for GAD. CBT should be tried first as the initial form of treatment, given its effectiveness, unless symptoms are highly debilitating and/or the patient prefers medication to ameliorate the distress more rapidly.
Can GAD be overcome through treatment or is the goal primarily to improve the quality of life of the sufferer?
Many patients can overcome their GAD and become free of symptoms with appropriate treatment. However, a sizeable number of individuals with GAD find that their symptoms wax and wane around increased responsibilities and stressors due to change, uncertainty, and life transitions. In these cases treatment and post-treatment outcomes need to be more modest and acceptance is central for the sufferer of GAD in the recovery process.
Do you treat other disorders besides GAD?
I have a general psychotherapy practice, so I do treat other anxiety disorders, mood disturbances, interpersonal difficulties, and severe mental illness.
What is your approach to the treatment of GAD and other anxiety- related disorders?
My main approach to treating GAD is the use of cognitive-behavioral therapy (CBT). CBT focuses on the present, is structured, often time limited, collaborative, and tools/skills building. However, I do also use evidence-based psychodynamic therapy acceptance and commitment therapy and integrative psychotherapy. Therapy always needs to be tailored to the unique needs and clinical presentation of the person.
How did you initially get involved in GAD and how has this propelled you to become an authority in the field?
My interest in GAD started in graduate school with a paper on the subject, followed by a doctoral dissertation. Soon after, in my clinical training and then in private practice, I began to see many patients with GAD. Subsequently, Dr. Aaron Beck (the founder of CBT), Dr. Vladan Starcevic (an expert on anxiety disorders), and Dr. John Riskind (a leading figure in the CBT and anxiety field) greatly influenced and shaped my thinking on GAD. I also felt GAD was being neglected, even by mental health professionals, and viewed as a highly misunderstood anxiety disorder. My nature is to advocate for the “underdog” and GAD sufferers needed a voice. So, I felt a strong calling to become one of their voices. My status as an authority on GAD continues to be a source of surprise and excitement at the same time.
Tell us a bit about the research you have done on GAD.
My research has evolved over time. I have written a full-length book on the subject, been the guest editor for a special issue on GAD, authored a chapter on GAD, and written other publications. The work task force on GAD and other anxiety disorders for DSM V (the most recent diagnostic manual for mental disorders) factored in several recent publications co-authored by myself with Dr. Beck and Dr. Starcevic and retained the name GAD with the same symptom criteria. This felt like a significant moral victory for us as clinicians/researchers and those that suffer from GAD.
Tell us about your soon-to-be released book, The Restless Mind – Understanding Generalized Anxiety Disorder. How does it differ from your previous book on the topic?
The Restless Mind is being written for an intelligent lay readership of potential GAD sufferers and their support systems. They are the primary target audience. Yet, fellow clinicians, researchers, students in mental health and others interested in learning about GAD can also benefit from this new offering. It is less academic, more accessible, practical, and self-help oriented than my first book on GAD. Plus, it will be more affordable in price.
What advice would you give to family members of those suffering from GAD or other anxiety disorders?
My recommendation to family members is always be compassionate, accepting and supportive. GAD, not unlike other anxiety disorders, is a genuine, painful malady and an individual with the disorder should not simply be dismissed as “the worried well.” Encourage, in a diplomatic way, the seeking of treatment by a highly experienced mental health professional who is well trained in CBT for GAD or anxiety disorders. Psychiatrists and other physicians versed in GAD or anxiety are the ones responsible for prescribing medication, if necessary. They are important members of the treatment team. Plus, reading my upcoming book on the subject will offer even more practical and hands-on advice!