Anxiety is not only ever-present, it is ever-threatening. It is a phantom that steals people’s freedom. Living with panic attacks is like belonging to a street gang: one must always be on the alert for personal slights or threatening movements. Everyday experiences, such as being seated in a restaurant, become crucial battlegrounds.
Anxiety attacks anything and everything in a person's life. Sometimes the targets are the mundane activities that others take for granted. At other times, it attacks more fundamental functions, such as one's ability to work or to love. We are used to thinking of people who are afraid to speak in public or to drive across a bridge as anxious. We are all familiar with a few stereotypical worrywarts. But anxiety influences a much broader range of behaviors. To the ordinary observer, people who are rude in a restaurant, obnoxious at their child's soccer game or overly exacting of their employees might seem simply self-centered. But often, these individuals are dealing with a wide variety of inner phantoms.
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.
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.
During the second session, we usually begin to practice diaphragmatic breathing and progressive muscle relaxation. I also give clients a tape recording of a 30-minute relaxation program. For homework, I instruct them to practice the breathing for five minutes, three times each day, and to listen to the tape daily. We take considerable time during our sessions practicing these techniques, but the clients need to practice at home, too.
If by the third or fourth session a client is not practicing breathing and using the tape, therapy is unlikely to be successful. I have tried numerous times to explore other issues or confront resistance at this point. It rarely helps. Sometimes clients are simply not ready to do the work necessary to create change.
But clients who commit themselves to learning to breathe and to purposefully relaxing when confronted with anxiety-producing events progress quickly. They begin to believe they can regain control over their lives, and often, they do. In most situations, these clients are usually able to end this episode of therapy after eight or ten sessions.
The Uses of Anxiety
Over the time I have worked on anxiety disorders, I have arrived a conclusion about the nature of these conditions. Anxiety disorders are a means of keeping the external world at bay.
In my view, anxiety has less to do with repression than deflection. Anxiety keeps new ideas and information out of a person's awareness. It saves overloaded mental and emotional circuits from additional strain. It is a sea wall built against the tide of physical circumstance.
In therapy I attempt to break this cycle and help clients come to terms with both their internal and external worlds. I try to help them understand that the tranquility they are seeking through repression can only be found by accepting the legitimacy of their own needs. When they grasp this, they can assimilate new information and develop new ways of living.
Learning to Listen
Once the alarms of the body are silent---once the body component of the mind-body equation has been successfully treated---therapy becomes a reflective process with an emphasis on accepting the importance of subjective experience.
On a concrete level, one of the best strategies for hearing the subjective voice is to continue the practice of diaphragmatic breathing several times a day, until it becomes a natural process: breathing deeply and listening deeply throughout the day. In this way, people can hear their inner voice and weave its wisdom into their responses to the demands of life.
In many clients, the knowledge of diaphragmatic breathing is like a slowly germinating seed. Because it is a physical skill, even those who show little interest in it during therapy can master it later without a therapist's help.
This blog is excerpted from “The Anxious Client Reconsidered." Read the full article here. >>
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