Anxiety Disorders

Getting rid of anxiety disorders isn't the same as taking out the trash. If you take your trash out to the curb, it's gone forever, and won't come back. But when you try to dispose of chronic anxiety, you will often find that this task is more like the child's game, "Whack a Mole", than it's like taking out the trash. Each time you hit a mole, more moles pop up. Every effort that you make to fight against anxiety, invites more of it.

So you need to be able to work smart, not hard. This guide will help you do that.

The Anxiety Trick

The fears, phobias, and worry that you experience with chronic anxiety often seem "irrational", and difficult to overcome. That's because there is a "Trick" to chronic anxiety problems. Have you ever wondered why fears and phobias seem like such difficult problems to solve? The reason is that chronic fears literally trick you into thinking and acting in ways that make the problem more chronic. You can't learn to float through anxiety and worry if you don't understand the Anxiety Trick.

The outcome of the Anxiety Trick is that people get fooled into trying to solve their anxiety problems with methods that can only make them worse. They get fooled into "putting out fires with gasoline".

The Key Fears

There are six principal anxiety disorders. The fears are different, but each one relies on the same Anxiety Trick, and draws upon the same kinds of anxiety symptoms.

And in each case, the person tries to extinguish the fears by responding in ways that actually make the problem worse and more chronic. Here are the key fears, and typical responses, of each anxiety disorder.

Panic Disorder and Agoraphobia

A person with Panic Disorder and Agoraphobia fears that a panic attack will disable him in some way - kill him, make him crazy, make him faint, and so on. In response, he often goes to great lengths to protect himself from a panic attack, by avoiding ordinary activities and locations; by carrying objects, like water bottles and cell phones, that he hopes will protect him; by trying to distract himself from the subject of panic; and numerous other strategies will ultimately make the problem more persistent and severe, rather than less.

Social Anxiety Disorder (or Social Phobia)

A person with Social Phobia fears becoming so visibly and unreasonably afraid in front of other people that they will judge her as a weak, inadequate person, and no longer associate with her. In response, she often goes to great lengths to avoid social experiences, hoping that this avoidance will save her from embarrassment and public humiliation. However, her avoidance of social situations leads her to become more, rather than less, fearful of them, and also leads to social isolation.

The fear of public speaking, and the broader fear of stagefright are considered to be specific instances of Social Phobia.

Specific Phobia

A Specific Phobia is a pattern of excessive fear of some ordinary object, situation, or activity. A person with a fear of dogs, for instance, may fear that a dog will attack him; or he may be afraid that he will "lose his mind", or run into heavy traffic, on encountering a dog.

People with phobias usually try to avoid what they fear. Unfortunately, this often creates greater problems for them. Not only do they continue to fear the object, but the avoidance restricts their freedom to enjoy life as they would see fit.

A specific phobia is usually distinguished from Panic Disorder by its narrow focus. A person with a fear of flying who has no fear of other enclosed spaces would likely be considered to have a specific phobia. A person who fears airplanes, elevators, tunnels, and bridges is usually considered to have Panic Disorder or claustrophobia. However, the fear of public speaking is usually considered to be a part of Social Phobia. A person with a Blood Phobia may fear a variety of situations, but they all involve the prospect of seeing blood. What's more, the official definitions of some of these disorders will change in 2013, so don't get preoccupied with the label.

Whether you have one or multiple phobias, these are very treatable conditions.

Obsessive Compulsive Disorder (OCD)

A person experiences intrusive, unwelcome thoughts (called obsessions) which are so persistent and upsetting that he fears the thoughts might not stop.

In response, he tries to stop having those thoughts with a variety of efforts (called compulsions). Unfortunately, the compulsions usually become a severe, upsetting problem themselves.

For example, a man may have obsessive thoughts that he might pass swine flu on to his children, even though he doesn't have the flu himself, and wash his hands repetitively in an effort to get rid of that thought. Or a woman may have obsessive thoughts that she left the garage door open, and repeatedly check the garage all night in an effort to stop thinking that. Not only do these efforts fail to rid the person of the unwelcome thoughts, they become a new form of torment in that person's life.

Generalized Anxiety Disorder

A person with Generalized Anxiety Disorder worries repeatedly and continually about a wide variety of possible problems, and becomes so consumed by worry that she fears the worry will eventually kill her or drive her to a "nervous breakdown". In response, she often tries a wide variety of "thought control" methods she hopes will enable her to "stop thinking about it." Distraction is one such effort. Unfortunately, the effort to stop thinking about it actually makes the worrisome thoughts more persistent.

Post Traumatic Stress Disorder (PTSD)

A person who has witnessed or experienced some dangerous or life threatening event (a shooting or a car crash) fears that the subsequent thoughts and powerful reminders of that event will lead to a loss of control or mental illness. The powerful symptoms of fear and upset a person experiences when recalling a terrible event are reactions to that event. However, the person gets tricked into responding to these reactions as if they were warnings of an upcoming danger, rather than reminders of a past one.

And Depression, too?

It's very common for people to experience depression in response to the way anxiety has disrupted their lives. Less frequently, sometimes people experienced a strong depression before the anxiety set in, and this is a different kind of problem. Either way, depressive symptoms need to be addressed in recovery, so it's useful to know something about how depression and anxiety disorders are related.

 

First Steps to Overcoming Anxiety

Overcoming anxiety after it's developed into a major difficulty in your life can often be confusing and upsetting. However, anxiety disorders are very treatable problems.

This article is a consumer guide for people who seek anxiety relief, but don't know how to get there. However, I suggest that everyone who seeks relief from chronic anxiety should review these steps, and complete any which you haven't yet done.

Step One:
Learn a little about anxiety disorders

Understanding how anxiety "works" is one of the keys to overcoming anxiety. Read my description of the different anxiety disorders and compare your experience with those descriptions. Take a look at these sites, which offer a wealth of consumer information about anxiety disorders, anxiety treatment, and overcoming anxiety:

ADD SITES

Use these sites to learn more about overcoming anxiety disorders. The purpose here is not to self diagnose yourself - please consult a licensed clinician for a diagnosis - but to inform yourself as much as possible before you consult a clinician so that you can evaluate what a clinician tells you, be an informed consumer, and find effective methods for overcoming anxiety.

It's common to experience some depression along with an anxiety disorder, and this is often a source of confusion to people. If this sounds relevant to you, read a little bit about depression.

Step Two:
Consult with your primary physician

A consultation with your physician is a must if you suspect you have panic attacks or generalized anxiety.

These symptoms can be caused by a variety of physiological disorders, and you should rule them out as part of the diagnostic process. You should certainly have one complete physical after the onset of these symptoms.

The other anxiety disorders don't generally require a physical, because there isn't any reason to think that they are caused by another physical ailment. However, you might still want to consult your physician, especially if you have a long history with that person. You might want his/her opinion about your situation; you might want a referral; or you might want to find out about possible medications you could use.

Be aware, however, that most physicians, because they specialize in various aspects of physical health, have very little training in the area of anxiety disorders. What training they do have, with respect to overcoming anxiety, is usually limited to medications. They may often be surprisingly unaware of cognitive behavioral treatment for anxiety disorders, even though it is generally regarded as the treatment of choice. When it comes time to seek professional help for overcoming anxiety disorders, you will probably need to go elsewhere.

If you don't have panic attacks or generalized anxiety, and have no other reason to consult your physician about overcoming anxiety, then skip ahead to Step Three.

Before you call for an appointment, make some written notes of what you want to discuss with your physician. The doctor's staff will probably ask you why you want an appointment; tell them that you've been having some problems and summarize them, briefly.

Many people have a fear of doctors, and have trouble making an appointment. This is a phobia, and will generally respond to the same CBT approach, once you decide that a visit to the doctor, however anxiety provoking, is in your best interest.

What to Expect from Your Physician

Your physician should listen to your symptoms, review your history, ask questions, and offer feedback and recommendations for overcoming anxiety. Since most physicians are trained principally in physical health and medicine, there is no reason to expect him/her to be an expert in anxiety disorders. However, your physician should take your complaints seriously, evaluate them, and offer suggestions for finding additional help.

If you are having panic attacks and have never been tested for thyroid malfunction, for instance, you should receive such a test, because thyroid problems can sometimes cause a person to have panic-like symptoms. If your symptoms resemble those associated with mitral valve prolapse, you should probably have an echocardiogram to evaluate that possibility. There are numerous physical conditions which can produce panic symptoms, and your physician should evaluate you for those possibilities if that has never been done before.

However, if you have had those tests before, and your doctor assured you that you were in good health, do not push for continual retesting! Many people do this because they hate the idea that they may have an anxiety disorder, and instead hope to find a physical problem. You can waste lots of time and money this way.

One set of tests is generally enough. If you need a second opinion for a particular reason, then get one. If you get more than two sets of tests, seriously consider the possibility that you are getting diverted from your task of overcoming anxiety!

Let's suppose that you've had a good consultation with your physician, the appropriate tests have ruled out any physical ailments which could be causing your symptoms, and you want to get professional help with overcoming anxiety. Now you're ready for step three.

Step Three:
Learn about the available treatments

There are basically two kinds of treatment which clinical research has shown to be effective in overcoming anxiety disorders: cognitive behavioral treatment (CBT) and certain forms of medication. Other forms of psychotherapy are often helpful in resolving some of the issues associated with anxiety disorders, but are generally not regarded as capable of resolving the primary problem. Which form of treatment should you choose?

My view is that most people with anxiety disorders are best served by trying a cognitive behavioral treatment first, and seeing what kind of results you get from that. You can always try medication later, if the CBT doesn't provide all the results you seek.

There are three principal reasons to try CBT first. First, unlike medication, CBT has no side effects. Second, the use of medications tends to lead a person to believe that he or she is now "protected" from anxiety disorders, and the sense of being protected often leads an anxiety sufferer to feel more vulnerable in the long run. Third, the results you get from CBT treatment will generally be much more long lasting than those you get from medications. Results from medication treatments tend to fade after the medications are withdrawn.

Some patients will need medication in addition to CBT, and some will not, depending on the severity of their condition and their particular diagnosis. Medication is nothing to be avoided if it seems necessary. However, I do believe it's true that in our culture, medications are overprescribed for these problems. This can be avoided if you start with CBT first.

There are new forms of CBT in development, often labeled as "Third Wave" therapies. One in particular, Acceptance and Commitment Therapy (ACT) is quite useful in the treatment of Panic Disorder and other anxiety disorders. In my work, I blend methods from both traditional CBT and ACT, and find them both very useful in overcoming anxiety disorders.

Do I Need "Treatment" at All?

You may be wondering if you really need to see a professional, or if you can't just solve this problem on your own. In general, the more difficulty you are having, the more you may need professional help, but only you can decide how urgent your need is. Certainly there are many good sources of self help information you can use in overcoming anxiety disorders. If you choose to try anxiety self help, I suggest you follow a few guidelines.

* Get a "buddy", a coach, or a support person, with whom you can discuss your efforts on a regular basis. They don't have to be an expert. A major benefit is that, by telling someone of your efforts, you will find it easier to monitor your progress and hold yourself accountable. It's easy to forget about all your good intentions when you keep them to yourself.

* Follow an organized plan. Find a good self help book which pertains to your problem, and make that the basis of your work. If you have panic attacks and like the approach you find on this website, then try my Panic Attacks Workbook.

* Evaluate your progress at regular intervals, at least monthly. After six months, re-evaluate your progress. If you're satisfied you're making reasonable progress toward overcoming anxiety, continue on course. If you're not, consider seeking professional help at that time.

* Sign up for my free e-mail newsletter for more thoughts and suggestions for overcoming anxiety.

What about Group Treatment?

Among the advantages of group treatment for overcoming anxiety are lower cost and the opportunity to share experiences with others who can relate to your situation. This can be particularly important for people who feel especially ashamed and imagine that they are one of a very few who suffer in this way.

I don't really think there are any disadvantages to a well run group treatment, although many people shy away from it because they believe they would pick up more fears from hearing other people's problems. In my experience in running groups, this has not been a problem and, while people are usually quite nervous before the first meeting, their anxiety is usually much lower by the end of the meeting.

Group treatments are often not available, so consider yourself fortunate if they are offered in your area. Your own personal preference is probably the most important deciding factor in the choice between group and individual treatment.

...And Support Groups?

You may also find it helpful to attend a support group. There are general purpose support groups designed to help people with a variety of psychological problems, and there are anxiety support groups which have a more specific focus - anxiety problems in general, or specific anxiety disorders such as Panic Disorder, Obsessive Compulsive Disorder, etc.

I think most people with a clearly defined anxiety disorder are better served by a support group which focuses specifically on their kind of problem, if such a group is available. However, there are also some good "general purpose" groups, such as Recovery International.

Step Four:
Identify and Interview Some Therapists

If you decide to get professional help, be prepared to do some work to find a good therapist. You can start by getting the names of therapists in your area who offer the kind of treatment you seek. The websites of the Anxiety Disorders Association of America and the Association for Behavioral and Cognitive Therapies offer a "therapist finder" section to help you find a specialist in your area. The sites for the Obsessive Compulsive Foundation and the Trichotillomania Learning Center (compulsive hair pulling) offer similar lists of professionals who specialize in those areas.

You will probably be better off if you can find a therapist who has specialized training and experience with the anxiety disorder for which you seek help. However, be aware that these lists will generally include any therapist who wishes to be included; they are not a licensing or accreditation process, simply a place to start. You still need to be an informed consumer.

Step Five:
Select a Therapist and Begin Treatment

An initial evaluation with a therapist may take anywhere from one to two sessions. It should enable the therapist to learn enough about you to give you some feedback about your situation and how that therapist proposes to help you, and should also give you a chance to ask more questions. One area you should certainly discuss with the therapist is what to expect in treatment, i.e., how will you know it is working? What would be a sign that it is not working?

You will probably also want to know how long treatment will take. What I tell new patients is that, while I can't immediately predict how long their particular situation will require, I do expect that they will have a gut feeling that we are moving in the right direction within the first month of weekly sessions, and that they should see some progress within the first two months. If this doesn't happen, it's a sign that something isn't working right, and we should figure out what's wrong.

 

 

The Anxiety Trick

Have you struggled to overcome an anxiety disorder, only to get disappointing results, or even feel worse over time? You're being fooled by the Anxiety Trick.

This is a terribly common occurrence, and people mistakenly blame themselves for it. Here's a more accurate, and helpful, way to understand this common and frustrating problem.

What is an anxiety disorder? It's you getting tricked into feeling powerful fear in the absence of any danger.

It's because there's no danger that people seek help for these fears. People recognize that they're getting afraid when they're not in danger. If they were actually in danger, they would just protect themselves as best they could, and be better off for it.

With an anxiety disorder, people get afraid when they're not in danger. Their struggle to protect themselves from fear leads them down a path of increasing trouble. That's the anxiety trick.

How does this happen, that you feel fear in the absence of danger? This is the Anxiety Trick at work.

How You Get Tricked

* If you have Panic Disorder or Agoraphobia, you keep getting tricked into believing that you're about to die, go crazy, or lose control of yourself.

* If you have Social Phobia,you keep getting tricked into into believing that you're about to look so unreasonably nervous in front of people that you will be completely humiliated and be cast aside by your community.

* If you have a Specific Phobia, you keep getting tricked into believing that you're likely to be overcome by some external object (like an elevator) or animal, or by your fear of it.

* If you have OCD, you keep getting tricked into believing that you've set in motion a terrible calamity. You might fear that your neighborhood will burn because you left the stove on, or that your family will get poisoned because you mishandled the insecticide.

* If you have Generalized Anxiety Disorder, you keep getting tricked into believing that you're about to be driven mad by constant worrying.

In each case, the episode of fear passes without the expected catastrophe. You're none the worse for wear, except that you're more worried about the next episode. The details seem different, but it's the same anxiety trick.

What is the Anxiety Trick?

The Anxiety Trick is this: You experience Discomfort, and get fooled into treating it like Danger.

What do we do when we're in danger? We only have three things: Fight, Flight, and Freeze. If it looks weaker than me, I'll fight it. If it looks stronger than me, but slower, I'll run away. And if it looks stronger and faster than me, I'll freeze and hope it doesn't see so good. That's all we have for danger.

When people experience the fear of a panic attack, or a phobic encounter, or an obsessive thought, they instinctively treat it as a danger. They try to protect themselves, with some variation of Fight, Flight, or Freeze.

How People Get Tricked

People's natural instincts to protect themselves are what lead them to get tricked. See if you recognize your responses in these examples below.

A person with Panic Disorder gets tricked into holding her breath and fleeing the store (highway, theater, or other locale), rather than shifting to Belly Breathing. and staying there until the feelings pass.

A person with Generalized Anxiety Disorder gets tricked into trying to stop the unwanted "what if?" thoughts, rather than accepting them and taking care of present business as thoughts come and go.

A person with Social Phobia gets tricked into avoiding the party, or hiding in the corner if he attends, rather than say hello to a stranger and see what happens.

A person with OCD gets tricked into repeatedly washing his hands, or returning home to check the stove, rather than accepting the intrusive thoughts of contamination and fire and returning his energies to the present activities at hand.

A person with a dog phobia gets tricked into avoiding the feelings by avoiding all dogs, rather than spending time with a dog until the feelings pass.

What Maintains the Anxiety Trick?

You might wonder, why don't people come to see this pattern, of repeated episodes of fear which don't lead to the feared outcome, and gradually lose their fear?

The answer is this. They took these protective steps, and there was no catastrophe. They tend to believe that these steps "saved" them from a catastrophe. This thought makes them worry more about "the next time". It convinces them that they are terribly vulnerable and must constantly protect themselves.

The actual reason they didn't experience a catastrophe is that such catastrophes are typically not part of a fear or phobia. These are anxiety disorders, not catastrophe disorders. People get through the experience because the experience isn't actually dangerous. But it's understandably hard for people to recognize that at the time. They're more likely to think they just had a "narrow escape". This leads them to redouble their protective steps.

It's the protective steps which actually maintain and strengthen the Anxiety Trick. If you think you just narrowly escaped a catastrophe because you had your cellular phone, or a water bottle; or because you went back and checked the stove seven times; or because you plugged in your iPod and distracted yourself with some music, then you're going to continue to feel vulnerable. And you're going to get more stuck in the habit of "protecting" yourself by these means.

This is how the problem gets embedded in your life. You think you're helping yourself, but you've actually been tricked into making it worse. That's how sneaky this Trick is.

This is why my patients so often say, "the harder I try, the worse it gets". If the harder you try, the worse it gets, then you should take another look at the methods you've been using. You've probably been tricked into trying to protect yourself against something that isn't dangerous, and this makes your fear worse over time.

How Can You Overcome
The Anxiety Trick?

The thing that makes fears and phobias so persistent is that virtually anything you do to oppose, escape, or distract from the anxious feelings and thoughts will be turned against you, and make the anxiety a more persistent part of your life.

This is why people notice "the harder I try, the worse it gets". They're putting out fires with gasoline.

If you come to see that you've been putting out fires with gasoline, you may not have any idea what to do next. But the first step is always the same: put down the buckets. Stop throwing gasoline on that fire.

This is where the cognitive behavioral methods of desensitization and exposure come in. They're intended as methods by which you can practice with (not against) the symptoms, and become less sensitive to them. As you lose your fear of the symptoms, through this practice, that's when the symptoms will fade.

All too often, people get the idea that exposure means going to a place or situation where you're likely to get anxious, perhaps a highway or an elevator, and take a ride without getting anxious. That's not the point! The point is to actually go there and feel the anxiety, being sure to stay there and letting the anxiety leave first. This is what called floating.

The way to disarm the Anxiety Trick is to increasingly spend time with anxiety, to expose yourself to the thoughts and sensations, and allow them to subside over time.

What can you do to make the experience of exposure more tolerable? You can use the AWARE steps as a general guide for how to conduct yourself while doing exposure.Always keep in mind that exposure is practice with fear, and do nothing to oppose, avoid, or distract from the fear during exposure.