Anxiety

Worry

Most people worry to some extent, but some people worry excessively, whether they need to or not. It’s as if their brain is a worry machine and they can’t find the “OFF” switch.

The excessive worrier jumps to worse case scenarios. If he has a headache for several days in a row, he doesn’t assume he’s having tension headaches. He’s more likely to think, “Oh my God, I must have a brain tumor.” Other explanations, if they are considered at all, are bypassed on the way to the worst possible outcome.

Worry is typically concerned with ordinary realms of life: health, finances, relationships, job, children. Worry is a form of anxiety.

Excessive worry can disrupt sleeping patterns because it increases bodily arousal. Worries can distract us, making concentration difficult, which is why it is sometimes mistaken for ADHD. Worry can also be a burden to the worrier’s spouse or significant other because the worrier may need constant reassurance that worry isn’t likely. All in all, excessive worry is exhausting.

When I work with someone who worries too much, the first thing I do is ask them to externalize their worries, i.e., talk about them in the session, in considerable detail. We unpack them one-by-one. Invariably, we’ll discover what cognitive therapists call “thinking errors.” Some these might be:

  • Confusing the possible with the probable. (Very common thinking error)
  • Failing to consider the simplest explanations first.
  • Assuming that if a worry comes true one won’t be able to cope.
  • Over-estimating the relevance of someone else’s health problems to one’s own life.
  • Confusing prevalence with salience. (e.g., plane crashes are salient but not prevalent)

What we do in therapy is try to put the worrisome thoughts
back into perspective. Just because something is theoretically possible it doesn’t make it likely. And if x should happen, well, what would you do then? You might as well answer the question. It takes courage to face your fears –– even when they are hypothetical. But this is one way you have of not letting them control you. So I might ask, “Have you ever coped with anything like this before? Has anyone else? If so, what have they done?” Or: “Objectively speaking, how bad is this fear?”

Anxious thoughts are future-oriented. It’s as if we’re scanning the road ahead of us, watching out for the threat of danger. In therapy, I ask people to identify the threat. Frequently the threat can be reduced. For example, driving defensively, sober, without looking at your smart phone, will drastically reduce the odds of getting in a car accident. Note, however, that the risk is not eliminated, just reduced to manageable proportions.

People who struggle with worry often wish that therapy will banish their anxiety and fears completely. But of course life seldom works that way. There are some things we control and many things we do not. But some threats, perhaps most, can be reduced enough so that we don’t need to stay vigilant about them.

And yet, it takes time to turn off the worry machine. It takes focused attention to practice new thinking skills and regain perspective. Which isn’t to say we should never anticipate dangers or scan the road ahead for threats. Indeed, it is probably adaptive to devote a certain amount of attention to these things. It’s just that it seldom helps us to stay stuck in this mode.


Anxiety


Sometimes people will come to therapy hoping that I can make their anxiety disappear, as if by psychological surgery. Almost as if anxiety is the psychological equivalent of an appendix. But therapy doesn't remove anxiety so much as help you learn to dial it back.

If your anxiety (apprehension, worry, panic attack, social discomfort, performance anxiety, etc) is running at about an 8 or 9 on a scale of 1 to 10 with ten being high, dialing it back to a 4 or 5 can make a huge difference.

But we never really eliminate anxiety altogether, any more than we eliminate other negative emotions like fear, anger, or sadness. Our emotions make us human, but they also help us make decisions. (Without emotions, we would have no values. Values tell us what's important to us.)

Anxiety is an emotional state that signals danger or threat or concern. We don't want to cut this out of your psyche. You need this signal. Life is sometimes dangerous or threatening. But too much anxiety, especially without the governing power of reason, spells trouble.

Or rather, avoidance.

Avoidance becomes its own problem. Avoidance robs you of life.

If anxiety is robbing your life, get help. Dare to try to therapy. Sure, you can read this blog post or read a book, and these are great ways to get information, raise awareness. But therapy helps you implement information. Therapy is an experience.

If you dial back your anxiety by just a few percentages points, you might live just a bit more fully. You might enjoy being alive again.


Related post: Brief Thoughts About Anxiety

The Consumer Reports Survey on Anxiety and Depression

A recent article in the July 2010 Consumer Reports presents the results of a survey they did with their readers about getting help for Anxiety and Depression.

Conclusion: their sample of readers felt both that both “talk therapy” (psychotherapy) and medication were each effective, but combining the two yielded the best results.

No surprise, here. These findings are very much in line with the behavioral research on the topic. (True clinical studies typically measure outcomes and employ appropriate control groups.)

I often see people in my practice who do not want to go on medication, largely because of side effects. I’m not against medication; I just happen to provide therapy. If my patients want medication I will happily refer them and let them come to their own conclusions about the value medicine in their lives, which I think is the best way to do it. On occasion, I will also see a patient who does not want talk therapy, but only wants the pills. I have no objection to this, either.

What I do find, however, is that often medication treatment alone is good so long as one stays on the medication. If the medication is discontinued -- without psychotherapy -- the symptoms may relapse. This, too, is in line with current research.


A different view of antidepressants was discussed in this post: Antidepressants Don’t Work...Can this be true?

Brief Thoughts about Anxiety


The National Institute of Mental Health has a great page devoted to anxiety disorders. You can find it here.

According to the site: “Anxiety is a normal reaction to stress. It helps one deal with a tense situation in the office, study harder for an exam, keep focused on an important speech. In general, it helps one cope. But when anxiety becomes an excessive, irrational dread of everyday situations, it has become a disabling disorder.”

Here are the five kinds of anxiety disorders:

--Generalized Anxiety Disorder
--Panic Disorder
--Obsessive Compulsive Disorder
--Social Anxiety
--Post-traumatic Stress Disorder

Generalized Anxiety is worry, worry, worry, and then more worry. The worry switch just won’t turn off.

A panic attack is akin to intense fear or terror -- but without any obvious event or stimulus to provoke it.

OCD is repetitive behaviors (compulsions) and repugnant thoughts (obsessions) that one cannot stop.

Social Anxiety is dread of common social circumstances.

PTSD is intrusive thoughts, flashbacks, extreme avoidance, intense anxiety, all tied to a prior highly stressful event.

We must differentiate normal anxiety for disordered anxiety. Anxiety in and of itself is not bad; indeed, we are all biologically equipped to feel it. When it comes to performance, for instance, anxiety can be quite helpful. Without some anxiety, the athlete, the musician, and the test-taker would suffer. A moderate amount of anxiety increases alertness, focus, and energy. As it turns out, performance tends to suffer when anxiety is either too low or too high.

When anxiety is too high, it disrupts our abilities to concentrate and focus, to remember and process information, to feel calm, and to function. Although we think of anxiety as an emotion, it affects thinking, behavior, and body as well. Anxiety disorders frequently coexist. One may be both a worrier and a panicker at the same time. This probably because the disorders -- which are really symptom patterns -- may share the same underlying mechanisms.

The goal of treatment is not to eliminate anxiety, but to dial it back to acceptable levels.

Tip for Coping with Agorophobia

Anxiety tip: Retreat vs. Avoidance

Anxiety and avoidance go hand-in-hand. Where you fine one, you find the other. When I help people reduce or eliminate panic attacks, we often have two goals: reducing the panic attacks themselves, and reducing the accompanying agoraphobia.

A panic attack is an intense state of fear or terror without an obvious external stimulus. When people experience panic attacks over a period of time, they tend to avoid those places where the attacks occurred. When the avoidance gets to a point people have many places they simply refuse to go (e.g., busy traffic, large city, a large supermarket), we give it fancy diagnostic label: agoraphobia.

When you’re trying to break an agoraphobic pattern, it helps to differentiate between avoidance and retreat.

In the former, you avoid a physical place like crazy and try never to come back. In the latter, you may back away, but only because you can’t do it right this moment. The kicker is, with retreat you make agreement with yourself to come back to it. Maybe later today, maybe tomorrow, maybe next week or next month. But sooner or later you come back to it and -- this hard part -- you hold yourself to it.

Some clients will say I’m splitting linguistic hairs. And to degree that’s true. But the truth is, our ability to cope is not static. Some days we are better others: more rested, less stressed, more ready to face challenges, more courageous.

When you are trying to break an avoidance pattern you will most likely not get it right on the first try. You need to try and try again, and keep trying.

So if you approach something you fear, and can’t do it, you can either throw up your hands and give up, or make an agreement with yourself to come back to it. This is really all about building the right mindset. If you simply avoid, you build a mindset of failure. If you retreat, you build a mindset that makes allowances for approximations, false starts, and variable coping patterns. You also build a mindset of self-compassion, which is a critical ingredient in the world of personal change.



Another post for anxiety and/or stress: A natural cure for anxiety and stress: belly breathing.

Copyright 2008-2016 John Gibson. All rights reserved.