A New Way to Understand Severe Anxiety Disorder

A Client’s Severe Anxiety Disorder May Be a By-Product of a More Primary Purpose

Bruce Ecker

Marlene sat before me describing months of feeling “paralyzing” anxiety and helpless vulnerability to disaster. There were several very real sources of her severe anxiety disorder: Her parents were in medical crises, she and her husband were in a legal battle threatening the family’s home and savings, and some neighbors had become frighteningly aggressive over a squabble between their children. But why had Marlene’s anxiety become an oceanic severe anxiety disorder?

I decided to try a two-step approach that’s often an effective panic attack treatment when dealing with functionless symptoms. I suggested revisiting one of the situations she had told me about. “You’ve opened a piece of mail notifying you of the other party’s new legal maneuver, and you start to feel a whole new wave of vulnerability and fear. Now try to imagine what change or shift of any kind—whether in your attitude, behavior, belief, or perspective—would diminish this fear.”

Marlene’s somewhat hesitant words were a big surprise to me. “I’d have to fight back,” she said.

I now understood what was maintaining her severe anxiety disorder: if you’re under serious assault and don’t protect yourself by fighting back, you feel unbearably open to disaster.

Not fighting back, even though she was under attack, was what I should regard as Marlene’s “real” symptom. I assumed she had some definite, unconscious purpose for not fighting back when under attack. To find that purpose, I guided her into imagining fighting back in various bold ways.

She described a distinct discomfort, and what came into awareness were the rules of being a Good Girl in her strict Roman Catholic childhood. “All my life I’ve worked hard to be a Good Girl. If I got fierce and fought this battle, I’d no longer be a Good Girl—I’d be a crazy troublemaker.”

By getting directly in touch with how her severe anxiety disorder stemmed directly from her own deepest assumptions about the world, Marlene was also now in touch with her own agency in bringing about this symptom.

With the underlying material fully in view, I saw that Marlene’s severe anxiety disorder actually didn’t have a function—it wasn’t the means of carrying out her purpose of being a Good Girl. Rather, the unpresented symptom of not fighting back carried out this purpose, and her anxiety was its necessary by-product.

Six months after this session, Marlene reported that she’d soon begun to fight back through assertive communications and a demonstrated readiness to follow through with action. She said her anxiety was “hugely eliminated.” By making conscious her symptom-requiring position, she’d been able to revisit and revise that earlier life strategy.

Topic: Anxiety/Depression

Tags: anxiety disorder | assertive communication | panic attack | panic attack treatment | severe anxiety disorder

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Tuesday, September 8, 2015 5:55:59 PM | posted by What is Generalised Anxiety Disorder (GAD)? | therapysuffolk
[…] Some therapies, such as cognitive behavioural therapy (CBT) focus on the perceptual biases that cause the negative thoughts and expectations, and CBT has been found to help reduce these thoughts and responses. However, when challenges to thinking patterns are combined with a therapy that also looks at emotional reactions and learned behaviour from past situations, new learning can take place at a deeper level, preventing a reaction from taking place, rather than managing an arising reaction. Recently, therapies such as Emotional Coherence therapy have suggested that anxiety can stem from a positive attempt to keep an important, learned code of behaviour in place, which may no longer be in the person’s best interest and so creates internal conflict and anxiety. Find out more about how anxiety can be serving a real but unconscious process here. […]

Friday, May 2, 2014 2:59:12 PM | posted by Mark
I agree with post #2; I don't see how this is a new way to work with this client. This all seems like common sense and basic psychotherapy.

Thursday, May 1, 2014 9:55:40 PM | posted by daisys
Not so strange--I had a similar response in 2012 on realizing that Developmental Trauma wasn't going to be included in the DSM-5. How do I fight back against a whole entrenched system?
I went to a medical doctor and knew I had to discuss the physical aftereffects of extreme abuse--a severely damaged digestive/assimilative system that results in severe side effects with medication. Response--"you need to see a psychiatrist and be on meds" Don't want to take meds? You're medically noncompliant.
I face iatrogenic death.
So I signed up to comment on the psychotherapy networker.
Thank you for all that you're doing to get recognition of childhood interpersonal trauma.
Keep up the good work!
Find ways to involve survivors!

Tuesday, April 29, 2014 4:56:47 PM | posted by Matt Stone
I think this brief case study presented by Bruce Ecker is an important contribution for the clarity in which clinical technique and a specific mechanism of psychotherapeutic change is delineated. Descriptions of depth oriented psychotherapy are rarely as succinct or fully comprehensible. My two cents.

Tuesday, April 29, 2014 2:15:11 AM | posted by First Name Last Name
Usually people with anxiety are very difficult to respond to the need of "fight back" as they usually fear of losing control under such circumstance. To encourage or push client to fight back sometimes may have counter effect; as the result for their "fight back" may be undesirable which may worsen their condition.

Monday, April 28, 2014 7:47:23 PM | posted by Andy Hudak III
not sure how this can be considered "a new way", since a host of people Made this possible… starting in the 70s...of course, that WAS before the return to the medical model, and often a sadly superficial version of cognitive behavioral Therapy. In the past, I'm thinking of Milton Erickson's work, the NLP people, EMDR, and one could Even argue That the concept goes all the way back to Freud. Having said that does not make me any less grateful for seeing people reminding therapists regarding this lens through which to see anxiety disorders.

Monday, April 28, 2014 2:45:48 PM | posted by Randy Kamen Gredinger
Your insight into Marlene's anxiety seems spot on, However I often find that such awareness does not ultimately resolve a deep seated issue without the benefit of some additional tools. For example I think it would have been most beneficial if Marlene also learned how to self soothe through some breathing strategies that directly help the mind and body to relax. Insight plus practical tools that effect the sympathetic nervous system would cover the bases more deeply and broadly. DrRandyKamen.com