As therapists, we typically assume that a person suffering from severe anxiety is eager and motivated to receive the help we offer. But we should never naively underestimate clients’ hidden antipathy to change, despite their discomfort.
New Directions for Psychotherapy’s Most Common Problem
The Role of Temperament in Psychotherapy
The Ten Best-Ever Anxiety Management Techniques
By Margaret Wehrenberg
Facing Our Worst Fears: Finding the Courage to Stay in the Moment
By Reid Wilson
Nightmind: Making Darkness Our Friend Again
by Rubin Naiman
Sleepless in America: Making It Through the Night in a Wired World
By Mary Sykes Wylie
The Anxious Client Reconsidered: Getting Beyond Symptoms to Deeper Change
By Graham Campbell
Confronting the New Anxiety: How Therapists Can Help Today’s Fearful Kids
By Ron Taffel
Therapists, social workers, counselors and others found these articles helpful in learning more about causes and management of fear and anxiety; medication versus therapy as part of an anxiety treatment program for adult patients as well as teenagers and children. People searching for information on the following terms and concepts found these articles helpful:
…What is it about anxiety that's so horrific that otherwise high-functioning people are frantic to escape it? The sensations of doom or dread or panic felt by sufferers are truly overwhelming--the very same sensations, in fact, that a person would feel if the worst really were happening. Too often, these, literally, dread-full, sickening sensations drive clients to the instant relief of medication, which is readily available and considered by many insurance companies to be the first line of treatment. And what good doctor would suggest skipping the meds when a suffering patient can get symptomatic relief quickly?
But what clients don't know when they start taking meds is the unacknowledged cost of relying solely on pills: they'll never learn some basic methods that can control or eliminate their symptoms without meds. They never develop the tools for managing the anxiety that, in all likelihood, will turn up again whenever they feel undue stress or go through significant life changes. What they should be told is that the right psychotherapy, which teaches them to control their own anxiety, will offer relief from anxiety in a matter of weeks--about the same amount of time it takes for an SSRI to become effective.
Of course, therapists know that eliminating symptomatology isn't the same as eliminating etiology. Underlying psychological causes or triggers for anxiety, such as those stemming from trauma, aren't the target of management techniques; they require longer-term psychotherapy. However, anxiety-management techniques can offer relief, and offer it very speedily.
From Psychotherapy Networker magazine, September/October 2005
…Insomnia. Almost everybody has it at one time or another. Some poor souls live (or barely live) with it. It's hard to know exactly how widespread it is—prevalence rates are all over the map. As many as 30 percent of the population, or as few as 9 percent (depending on the source of the statistic, or how insomnia is defined, or what impact it has), suffer from some form of it at least some of the time. Critics maintain the higher estimates are overblown, partly by insomniacs themselves, whose suffering leads them to overestimate the time they spend lying awake (10 minutes of lying wide-eyed in bed feels like an hour) and by the pharmaceutical industry (that all-purpose villain) in order to sell billions of dollars in sleeping potions.
Definitions of insomnia are loose to the point of inanity. DSM-IV defines "primary insomnia" as "a difficulty initiating or maintaining sleep or experiencing nonrestorative sleep that results in clinically significant distress or impairment in functioning." Insomnia has been divided and subdivided into a bushy tree of overlapping categories: primary, comorbid (occurring with a boatload of mental and physical health problems), idiopathic (lifelong inability to sleep), psychophysiological (somaticized tension), paradoxical ("sleep-state misperception") childhood ("limit-setting sleep disorder"—parents don't enforce bedtime), food-allergy related, environmental, periodic (internal clock problem), altitude related, hypnotic, stimulant-dependent, alcohol-dependent, toxin-induced, menopausal, and age-related, among others.
Chronic insomnia is linked to a multitude of physical and psychological ills: increased risk of cancer, hypertension, heart disease, obesity, diabetes, infertility, miscarriage, depression, anxiety, irritability, dementia, impaired cognitive and reasoning skills, lowered immune-system function, heightened awareness of pain, and who knows what else? Probably bunions, dandruff, and pinkeye. But while insomnia apparently contributes to, results from, or is comorbid with the ailments on this laundry list, why we get insomnia, which parts of the brain are most implicated, and how it actually hurts us, even what it is exactly, all remain largely a mystery, as does sleep itself. Thus researchers summed up a lengthy 2005 National Institutes of Health report on insomnia with deadpan succinctness: "Little is known about the mechanisms, causes, clinical course, co-morbidities, and consequences of chronic insomnia."
What's undisputed, however, is that sleep is as necessary to physical and mental health as air and water, and that, without it, we suffer—often severely. So, those annoying world-beaters, who brag about needing only four hours of sleep a night (the better to forge multimillion-dollar start-ups and do their Nobel Prize–winning research) are perhaps not being entirely candid. According to sleep expert Thomas Roth of the Henry Ford Sleep Disorders Center in Detroit, "The percentage of the population who need less than five hours of sleep per night, rounded to a whole number, is zero."
From Psychotherapy Networker magazine, March/April 2008
The word psychopath distinguishes hard-bitten predators. Research shows a treatment center—run by shrinks, not wardens—has reduced new violent offenses by 50 percent. What accounts for the Mendota Treatment Center’s success?
In this age of helicopter parents and protective child professionals, we can often recreate a potent anxiety- reinforcing system around children that not only rewards anxiety, but encourages it to grow and take over even more of the child’s life.
Therapists make clients feel safe and secure, right? Well, when it comes to treating anxiety, more clinicians are instructing clients to ramp their fears, while telling themselves how much they welcome the experience.