by Kassandra Lamb
If you’re someone who has been dealing with an anxiety disorder for some time, you probably know as much or more about them than I do. But perhaps this post will offer some useful tidbits. If you’re newly diagnosed and/or finally focusing on how one or more of these disorders is controlling your life, this will provide an overview of what to do when anxiety takes over.
The Gold Standard of Treatment
Only two types of anxiety disorder are curable at this point in the history of the science of psychology. Specific phobias and some social phobias, such as fear of public speaking, are almost always learned reactions, although they are deeply ingrained in the cerebellum (as I mentioned in my last post on this subject) and do not respond well to conscious efforts to control them.
But they can usually be unlearned via a process of systematic desensitization. While practicing relaxation techniques, the person is gradually exposed to more and more of the stimuli that they are afraid of, whether it be heights or spiders or whatever.
For the other anxiety disorders, a combination of medication and talk therapy is the gold standard of care. Plus, there are a lot of other things one can do—lifestyle changes that can reduce the anxiety and make it more controllable.
Better living through chemistry. There are over a 100 drugs on the market today that affect anxiety in one way or another. The trick is finding the right one for you, and getting used to it.
But, again with the exception of phobias (and some versions of social anxiety), there is no other way to truly control the anxiety. The body is producing it, so it must be treated biologically.
Now, if you have a fairly mild case of an anxiety disorder, there are coping techniques you can learn that may be sufficient. But for most folks suffering from these disorders… the brain chemistry is broken, and it takes adjusting that chemistry through medication to get somewhere close to normal.
1. Finding the right meds for you.
First of all, consult a psychiatrist. Don’t rely on your family doctor for this. The brain is incredibly complicated, and scientists are learning new things about it every day. And there are many different meds, each with its own pros and cons, its own way of operating on brain chemistry. There is no way that a general practitioner can keep up with all that. So find a good psychiatrist—they are the doctors who understand psychoactive drugs—and preferably find one who specializes in anxiety disorders.
Secondly, give the meds a chance to work. Most anti-anxiety meds take several weeks to start to make an impact. The best way to find the right med for you is through trial and error, which takes patience. Yes, I know it’s hard to be patient when you are anxious ALL THE TIME.
But if you eliminate a med too soon, before it has had a chance to show what it can do for you, well, that might have been the best one for you and you passed it by, out of impatience.
2. Getting used to the meds.
Folks with anxiety disorders tend to become hyper-alert to changes in their bodies and brains. Feel a little lightheaded or queasy and immediately your mind jumps to the conclusion that a panic attack is starting up.
But psychoactive drugs, by definition, are going to make you feel different. Yes, it’s really, really hard to do, but try to ride out those odd feelings until they don’t seem so odd anymore.
(For more on anxiety meds, check out this article.)
The most commonly used approach in psychotherapy for anxiety disorders is cognitive-behavioral therapy (CBT). That’s psychobabble for the therapist is going to help you retrain your thinking and your behavior to lessen your anxiety and learn how to manage what’s left.
By definition, psychotherapy is a bit abstract and therefore hard to test scientifically, but cognitive-behavioral therapy is the most studied form of therapy—it has a lot of fairly concrete techniques that can and have been scientifically analyzed. And it has been found to be a very effective approach to anxiety disorders.
There are a lot of these CBT techniques, but two very commonly used ones are:
1. An A-B-C Assessment
A-B-C stands for Antecedent-Behavior-Consequence.
In other words, what proceeds the anxiety attack, how does the person respond to the anxiety behaviorally, and what is the consequence of that behavior. The antecedent can be an external trigger—anything from a loud noise to a weather or news report to a fight with your boss or spouse. Or it can be internal—a thought or feeling that gets things rolling.
Once the anxiety is running rampant, how does the person react? Do they become physically ill, do they hide from the world, lash out, have a drink (or several), try to pretend nothing is wrong (while anger and resentment builds up inside)?
Then the Consequence—how does the outcome then reinforce the behavior and/or the anxiety?
Ha, I bet you thought I was gonna say how does the behavior impact on the person. Well, often that is the problem. Hiding from the world (agoraphobia) definitely has a negative impact on the person’s life. But to break the pattern there’s a need to analyze how the avoidance behavior of not leaving the house is being REWARDED.
A person with panic disorder contemplates going out (antecedent), then they start to worry about having a panic attack while they are out among strangers, and how that will be so embarrassing and they won’t be able to get any help, etc. Then they decide not to go out after all (behavior), and the anxiety/worrying subsides a good bit (consequence). The avoidance behavior has just been rewarded by a reduction in anxiety.
The goal with an A-B-C assessment is to figure out where and how to break the cycle. (For more on ABC assessment, see this article.)
Which brings us to another CBT technique commonly used with anxiety disorders.
2. Changing Self-Talk
This is probably the simplest and yet most effective technique in a therapist’s toolbox. Have the person pay attention to what they are saying to themselves internally. And work with them to change those automatic internal ruminations.
Because almost always, self-talk is negative. “I’m going to screw up.” “This is going to be horrible.” yada-yada
People with anxiety disorders are NOT the only ones who tend to have negative self-talk. It’s very common in a lot of folks.
But those without anxiety disorders do not already have a constant sense of anxiety and impending doom coming from their faulty body chemistry. So they negotiate life’s twists and turns with mild to moderate insecurity, muddling through the things they’re sure are going to go badly and then breathing a big sigh of relief when it wasn’t all that bad after all.
And maybe they even gain a little confidence and are a little less negative next time.
But for folks with anxiety disorders, their self-talk often takes the form of “awfulizing.” Their already anxious minds immediately jump to the worst case scenario, and they quickly convince themselves that this is exactly what will happen, the most awful possible outcome imaginable.
Once the exact nature of a person’s negative self-talk is identified, the therapist helps them come up with good counter-messages. Not just some bland “Everything’s going to be okay,” but something specific, like, “I’ve dealt with this _________ (fill in the situation) before and handled it. I can do this.”
And then the therapist will use role-playing to help the person practice that new self-talk again and again. Until it becomes fairly easy to catch the negatives and switch gears, when out in the real world.
Again, there are more CBT techniques than these two, but this should give you an idea of what to expect in therapy.
Other Things You Can Do
1. Learn and Use Relaxation Techniques
Yoga, meditation, self-hypnosis, progressive relaxation, guided imagery, etc. Again, there are multiple options. Check them out until you find the one or ones that work for you. And then USE them. Every day, multiple times a day, and especially if you start to feel anxious.
2. Be Physically Active
Nothing reduces daily stress (which contributes to anxiety) quite like physical activity! Find an activity that you like, or at least can tolerate, and then make it part of your routine. Twenty-five to thirty minutes every other day is sufficient. More often is better.
And if your anxiety disorder has led to other issues, such as fibromyalgia, find a gentle way to be active. Yoga or swimming are great options.
3. Take Care of Your Body
Of course, all of us should be doing this, but if you have an anxiety disorder, this is CRITICAL. Develop a healthy eating plan, with nutritious foods that you LIKE. Make a point of going to bed at a consistent time each night, and develop a wind-down routine that helps you go to sleep more readily.
Again, experiment with different possibilities. Does reading work for you, or watching TV? Whatever you do, don’t do household chores or other stressful activities past a certain hour in the evening!
(She says as she is writing a blog post at eleven p.m…. Do as I say, not as I do. 😀 )
4. Avoid Self-Medicating
Alcohol and recreational drugs can backfire on you. They may help initially in small quantities, but their addictive tendencies and the development of tolerance can lead to more anxiety in the long run. And alcohol suppresses the production of melatonin, the hormone that promotes sleep. So it can contribute to insomnia big-time!
Also, nicotine is a sneaky drug. Smoking may make you feel more relaxed, but it is an illusion. Nicotine has a muscle-relaxant quality, which we feel almost immediately with each drag on a cigarette. But make no mistake, it is a stimulant. It increases your heart rate, your blood pressure, your muscle tension…i.e. your anxiety.
Caffeine can also be sneaky in its own way. I can’t begin to tell you how many people (my own husband included) have told me that “caffeine doesn’t affect me.”
Yeah, it does! But you’ve developed a tolerance for it so you no longer notice how it is affecting you. My husband eventually (not due to caffeine, due to aging) developed heart arrhythmia and had to cut back on his caffeine. He was amazed at how much calmer he felt and how much better he slept.
5. Break the Cycle
Do not let anxiety make itself at home. When you start to feel anxious, break the cycle. This may be through self-talk, or you may need to literally get up and move. Take a walk, read a book, watch TV, pursue a hobby. Do something that distracts your mind before it starts to awfulize.
6. Make a Commitment to Your Routine
Establish a routine of taking your meds regularly, paying attention to your self-talk, exercising, etc. And then when something knocks it out of whack, as life inevitably will—a holiday, a vacation, illness, etc.—make a point of getting back into your routine as quickly as possible afterwards.
7. Socialize and Seek Support
Make an effort to spend time with friends and family. Socializing is a great stress reliever and also a wonderful distraction from your worries. And finding a support group of people who are dealing with similar struggles can make the process so much more bearable. Google “anxiety disorder support” and your city and/or check out the websites of organizations like the National Alliance on Mental Illness (NAMI) or the Anxiety and Depression Association of America (ADAA).
I hope you find all this helpful.
Feel free to ask questions in the comments. I’ll answer as best I can. Also, if you have discovered something in particular that works for you, please share.
And I have a new release in my Kate Huntington Mysteries, Police Protection. To celebrate, I’ve put Anxiety Attack, the book before this new one, on sale for just 99 cents (through 5/24/19).
Anxiety Attack, in part, explores the experience of someone with social anxiety.
Kate Huntington’s P.I. husband had doubts from the beginning about this case, a complicated one of top secret projects and industrial espionage. Now one of his best operatives is in the hospital fighting for his life, and Kate believes the alleged shooter the police arrested—one of her psychotherapy clients who suffers from social anxiety—is innocent.
Tensions build between the couple, until a suspicious suicide brings the case to a head. Is the spy/killer tying up loose ends?
Almost too late, Skip realizes he may be one of those loose ends, and someone seems to have no qualms about destroying his agency or getting to him through his family.
JUST $0.99 ~ THRU 5/24/19
And Book #10, the last in the series, is here!! Just $2.99 during PREORDER and until after its release on 5/24 (goes up to $4.99 after that)
POLICE PROTECTION, A Kate Huntington Mystery
A story ripped from real-life headlines.
A police detective is found in an alley, standing over the body of an unarmed African-American boy. Groggy from a concussion, he has no memory of what happened, and he is literally holding the smoking gun.
To the Baltimore County Internal Affairs division, it’s a slam-dunk. But various forces push psychotherapist Kate Huntington and her P.I. husband to investigate behind the scenes, and what they find doesn’t add up. Why did the boy’s oldest brother disappear on the same day? And did the third brother, who’s on the autism spectrum and nonverbal, witness something relevant?
When seemingly unrelated events emerge as a pattern of intentional obstruction and diversion, it becomes apparent that what happened in that alley was more than just a bad shoot by a stressed-out cop. And for Kate, the case has become personal as she’s connected with the grieving mother, whose dead son was the same age as her Billy.
The answers may come from unexpected sources, but she and Skip better find them soon… before another life is lost.
Posted by Kassandra Lamb. Kassandra is a retired psychotherapist turned mystery writer. She is the author of the Kate Huntington psychological mysteries, set in her native Maryland, and a new series, the Marcia Banks and Buddy cozy mysteries, set in Central Florida.
We blog here at misterio press about twice a month, usually on Tuesdays. Sometimes we talk about serious topics, and sometimes we just have some fun.
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