Treatment for Anxiety
Anxiety is a condition which can affect us all at any time. A modest amount of it does no harm, in fact it can serve to keep us out of trouble. But too much anxiety can lead to symptoms such as panic, phobias such as agoraphobia and claustrophobia, stage fright, and so on. In extreme forms it can become paralysing, making it impossible to carry on the normal activities of living, working and relating to people.
In helping many people work through their anxiety in counselling and psychotherapy, I have come to the conclusion that there is always an underlying cause for the anxiety. It may not be easy to find the cause, as it may have happened at a time before the earliest memories, but I believe that the cause always exists. Some typical causes include
- Traumatic experiences, which can include a single major trauma, or a repeated series of less traumatic events
- Abuse - physical, sexual or emotional
- Having a parent or guardian who were themselves anxious
- Having parents who set impossibly high standards ("perfectionism"), or gave confusing messages (the "double-bind")
- Living in a family where a parent or sibling suffered from mental illness
- Experiencing abandonment in early childhood, such as the death or illness of a parent, or family breakup due to divorce
- Beginning a new long-term relationship, such as engagement or marriage
- Frightening experiences caused by using street drugs - a "bad trip"
- Experiences which disrupt the sense of self, leading to a feeling of fragmentation, dissociation or "cracking up"
One particular reason for anxiety which I have encountered in my practise is when a client has difficulty in saying "no", which can lead to pressure, stress and a feeling that one's life is out of control. If saying "no" is difficult, learning to do this appropriately can often have a dramatic effect in reducing anxiety and stress. An article "Anxiety and the art of saying No" is available on the downloads page.
Treatment of Anxiety
The methods for dealing with anxiety divide into two main approaches, although there can be considerable overlap, and most therapists will offer a combination of the two.
Psychotherapy attempts to uncover the cause of the anxiety in the past, by uncovering or reconstructing the past causes in childhood. Uncovering the cause of the anxiety allows the client to reprocess the experience with their adult mind, effectively "detoxifying" the feelings.
Counselling and CBT (Cognitive Behavioural Therapy) work more in the present, looking at coping strategies, working at confronting the anxiety and overcoming it by repeated exposure in small doses ("desensitisation").
CBT treatment of anxiety
When dealing with simple forms of anxiety where the trigger is clearly identifiable, Cognitive Behaviour Therapy (CBT) is one of the most effective treatments I have found.
Most simple anxiety problems can be summarised in a diagram similar to the one opposite. The trigger is the situation or event that sets off the feelings of anxiety or fear - it might be a an aminal, or a feeling of being trapped, or the way another person is behaving.
Once the anxiety is triggered we tend to do something to reduce it - this is called a safety behaviour. There are many types of safety behaviours - examples include avoiding the feared situation, seeking reassurance, distracting ourselves, using cigarettes, drugs or alcohol to calm ourselves, and performing rituals to calm ourselves.
The safety behaviour brings short-term relief, but in the long term it usually brings another set of problems. For example avoiding the trigger might make us feel better temporarily, but avoidance can lead to not going out, not being able to get a job, not making friends - life becomes very restricted and limited.
In the diagram the small arrows indicate how the problem is maintained - the short term relief that comes from a safety behaviour makes it more likely that we will keep doing the safety behaviour, the safety behaviour itself tends to cause the anxiety to seem worse, and fear itself makes us more vigilant, so more likely to react to triggers.
CBT treatment addresses the way the problem is maintained, because without these feedback loops the anxiety reduces of it's own accord. This is often done through exposure techniques that involve reducing the safety behaviours.