Anxiety therapy is likely the most common form of therapy sought by those who call us for a psychotherapy appointment. Anxiety can be painful and even crippling, dramatically interfering with one’s ability to create one’s life.
The first rule of anxiety therapy: Anxiety is something we produce, and an important part of life
As with many emotional experiences that can get out of control, anxiety has, in its origins, an important adaptive function as part of our emotional lives. This is crucial to understand in anxiety therapy. When we take on a new challenge, or when a challenge is presented to us, a modest amount of anxiety (or even a good deal of anxiety, in cases of serious challenges) is expected and can be helpful and doesn’t need to be treated with anxiety therapy. Unfortunately, it can be hard to sort out just when anxiety is helpful and just when it calls for anxiety therapy. What’s critical is this: if you’re creating your life, taking on new challenges, doing things that are a bit too hard for you (an important part of growing!), then you can bet you’re going to be anxious. It is essential to recognize this anxiety as something you’ve produced, as a result of having put yourself in a position to grow. When you own the anxiety, it can become less scary–it’s a part of you, not something that is happening to you.
In still other cases, anxiety gets out of control and anxiety therapy is called for. While every therapy for anxiety is different, we tend to see helping people grow in relation to their anxiety in therapy as involving two parallel tracks. The first involves learning concrete techniques in anxiety therapy for managing anxiety as it comes (including when it’s always or nearly always present). These include getting skilled at recognizing triggers, identifying the process of anxiety that is building early in its process, and making changes in behavior and thinking, which can include self-talk, creating distractions, reaching out to others who can help tackle the anxiety, and making use of physical exercise. The second track in anxiety therapy involves a broader exploration of what it means to create a life where anxiety has an increasingly smaller and smaller place. Typically, questions posed in this part of anxiety therapy are: What relationships and conditions are helping to cause the anxiety? What habits make you vulnerable to anxiety? What is the relationship between anxiety and difficulties with getting close to others?
Some clarifications regarding anxiety therapy
As with many therapy-related terms, it’s clear that anxiety refers to a variety of disparate thoughts, feelings and experiences. When contemplating anxiety therapy, clarifying these terms can help:
Many use the term stress and anxiety interchangeably, but anxiety therapy for stress needs clarifying. In this case, a complaint of anxiety commonly denotes physical symptoms, like exhaustion, difficulty sleeping, headaches or other kinds of tension; or problems in relationships, like difficulty controlling one’s temper or outbursts, or otherwise being irritable with friends and loved ones. Anxiety that is expressed as stress is a killer, can destroy relationships (along with brain cells), and is not a necessary or essential part of living a successful life. You can read more about psychotherapy for stress here.
For some, anxiety is experienced the most in social contexts. This is commonly referred to as social anxiety or social phobia. For some, this can be inexplicable, or it can be the product of repeated rejections earlier in life. Moving past social anxiety involves learning how be with other people. You can read more about social anxiety and social phobia here.
Panic attacks are acute episodes of intense anxiety, generally lasting anywhere from a few minutes to over an hour (or, in extreme cases, longer). It is important to remember that panic itself is an ordinary, expected reaction to traumatic experiences; what makes panic a panic attack, in my book, is when the panic seems inordinate when related to the circumstances surrounding it. In fact, most patients who complain to me about panic attacks have difficulty isolating any proximal cause.
Chronic anxiety and panic attacks often go hand-in-hand. Much of the help needed for panic attacks is outlined above–the first track involving concrete skills for preventing and minimizing the attacks, the second involving a broader project of ridding crippling anxiety from one’s life.
Anxiety therapy and it’s relationship to trauma therapy
As referenced above, not all anxiety is inexplicable. Whether we like it or not, when we experience serious trauma, we can often experience anxiety related to that trauma for months or years. Commonly, this sort of anxiety is called Post Traumatic Stress Disorder or PTSD, though this word can be intimidating–we all experience trauma in different ways, and I find it important to leave the question of what constitutes trauma open to the broadest possible interpretation. To put it differently, many who experience anxiety dismiss proximate experiences as silly (“It wasn’t really so bad.”); traumatic experiences are traumatic, no matter how insignificant we like to label them.
Group therapy as anxiety therapy
As I’ve said here a few times, in supporting someone with painful anxiety it is important to provide both short-term, immediate help, and at the same time to examine larger issues that produce ongoing anxiety. Group therapy is a tremendously helpful context in which to gain support in the difficult work of creating a life free of crippling anxiety. Why? Because group therapy is a great place to get help in developing at building relationships that support growth and development.
Anxiety therapy and alcohol, marijuana and other drugs
Absent alternatives for managing the painful aspects of anxiety, a great many people “use” alcohol and marijuana to temper their anxiety. Some may be aware that this is in play, while others may not be aware that it is their anxiety that is causing them to get into trouble with drugs and alcohol. Regardless, if cutting back or quitting drugs or alcohol is an objective, the role that these substances play in managing anxiety (and the question of what to do with all of that anxiety instead) is a critical one.
Psychiatric medications and anxiety therapy
Anxiety is second only to depression as the most common reason for the use of prescription psychiatric medications. (In fact, some of the medications used to treat depression are the very same ones used to treat chronic anxiety.) Many do receive short and long term relief from some of the extreme symptoms of anxiety through psychiatric medications; you can almost surely get relief. That said, many patients come to me with the expressed goal of avoiding psychiatric medications. There aren’t easy, straightforward answers, but it is important to know that there are alternatives to medication.