|The Anxious Client Reconsidered - Page 3|
Treating Anxiety Disorders
When I began working with anxiety disorders 10 years ago, I had little understanding, training or experience with these conditions. But I worked at a mental health clinic that was inundated by people suffering from panic attacks, and I saw this as an opportunity to broaden my skills and experience.
Starting from scratch, I began developing my expertise in obvious ways. I went to training seminars and read everything I could get my hands on. At one point, in the early 1990s, I had read every article about anxiety that had been published in The American Journal of Psychiatry and several other professional journals in the previous 10 years. I also sought supervision, and consulted with colleagues. And, of course, I observed and met with as many clients as possible. For a while, I saw everyone with an anxiety disorder who came into the clinic.
Eventually, I settled on the treatment program outlined by David Barlow in Master of Your Anxiety and Panic . In addition, I found the books Don't Panic by Reid Wilson and Finding Serenity in the Age of Anxiety by Robert Gerzon most helpful. The Barlow-inspired model I employed involved a time-limited, symptom-focused, cognitive-behavioral approach to therapy. It focused on teaching skills that enabled clients to deal with symptoms. Early in the process, I discovered that this model did what it purported to do--something of a rarity in the field. In addition, it placed great emphasis on education. I found that compelling because I know of no condition for which the dictum "knowledge is power" is more true.
Thus, I became an advocate of diaphragmatic breathing, progressive muscle relaxation and self-talk, and an example of an old therapist's (or at least a middle-aged one) learning new tricks. What I did not foresee was that cognitive-behavioral techniques, rather than obviating the need for a more probing therapeutic approach would, in many instances, prepare clients to benefit from deeper work. Developing new therapeutic tools for anxiety has broadened my therapeutic range and, paradoxically, confirmed my faith in my old tools.
In my initial session with clients, we develop a detailed history of the occurrence of their attacks. I also ask them to keep a record of each attack they experience during the first few weeks of therapy. Our goal is to understand what triggers these attacks. Even a partial explanation can help a client feel a greater sense of control and, not surprisingly, a sense of relief.
Early in therapy, my clients and I also discuss their diets in some detail. Because caffeine intensifies anxiety, I insist that they eliminate coffee, tea, chocolate, colas and all other forms of this seductive stimulant from their diets.