Anxiety
Overview of Anxiety: Anxiety is one of the most common reasons people seek therapy. Anxiety is defined as nervousness and an inability to relax. Some level of anxiety is normal in human beings; excessive anxiety can interfere with relationships, sleeping and eating patterns, work and school, and all areas of life.
• Body: People with anxiety may experience psychomotor agitation, pacing, shaking, trembling, quivering, sweaty palms, racing heartbeat, insomnia, tension, headaches, nausea, and difficulty breathing. A panic attack occurs when these somatic symptoms are severe and acute, sometimes mimicking the symptoms of a heart attack (though there is no record of panic attacks leading to actual coronary arrest).
• Mind: Anxiety can include racing thoughts, worries, excessive guilt, excessively fearful thoughts, obsessions, and magical thinking.
• Emotions: Anxiety is a dysphoric excitement or “apprehensive expectation” (DSM-IV), and may entail feelings of fear, confusion, frustration, and possibly shame and despair. Affect is worried and tense.
• Social: People who are anxious may display social avoidance, nervousness, neediness, blaming, and an inability to maintain relations or employment. Some people with anxiety can develop social phobia and agoraphobia, in which people experience intense anxiety in public and isolate in order to maintain a stable mood.
• Correlations: Anxiety is often associated with depression. Anxiety can take several forms, including phobias and obsessive-compulsions, which are addressed in separate sections. Anxiety is often found in people with psychotic symptoms, especially those who are paranoid. Anxiety is a symptom of Post Traumatic Stress. Anxiety in its most extreme form, as discussed above, can lead to a panic attack. Anxiety is also associated with passive personalities.
The Psychotherapy Model and Anxiety: The Psychotherapy Model views anxiety as a normal response to human experience and survival. Not unlike the fight, flight, or hide response, humans need anxiety in order to act and to protect from suffering. Because anxiety is normal, most people experience anxiety at some point in their life, however limited or mild. Yet, many experience a heightened and uncomfortable level of anxiety causing one to seek treatment. Rather than medicating the anxiety away as a permanent solution, the Psychotherapy Model approaches a person's anxiety with intense curiosity in an effort to help the person to understand and heal the source of the anxiety. Through the process of focusing internally a person can understand, unravel, and transform their anxiety. Sometimes anxiety is the result of an inner polarization (See Case Example: Anna). Sometimes anxiety is the result of unresolved trauma leaving the individual in a heightened physiological state of arousal in which certain experiences have the potential to reactivate the old trauma, as is often the case with Post-Traumatic Stress. Sometimes anxiety results from a lack of, or inexperience at, knowing how to self-sooth. And there are other psychological and emotional reasons for anxiety. Whatever the cause, anxiety can be reduced if not resolved completely with therapy. Indeed, anxiety may be hereditary to some degree, in that some people may be more predisposed than others to develop anxiety in response to life events. Whether one is predisposed to anxiety or not, there is nonetheless a great benefit in addressing anxiety with therapy.
The Medical Model and Anxiety: The Medical Model approach to the understanding and treatment of anxiety views anxiety as a disease or disorder of the nervous system. The most popular medical treatment of anxiety is medication, such as Celexa, Lexapro, Luvox, Paxil, Prozac, and Zoloft. These medications are helpful, and sometimes absolutely lifesaving for those who are paralyzed with anxiety or suffering intense panic. However useful these medications may be at symptom reduction, they fail to address the emotional and psychological causes of anxiety, which more often than not, play a powerful role in the formation and maintenance of anxiety.
Diagnostic and Statistical Manual of Mental Disorders (DSM): The DSM identifies eleven basic subtypes of anxiety disorders, most of which are addressed in separate sections. Criteria for generalized anxiety are as follows:
A. At least 6 months of "excessive anxiety and worry" about a variety of events and situations. Generally, "excessive" can be interpreted as more than would be expected for a particular situation or event. Most people become anxious over certain things, but the intensity of the anxiety typically corresponds to the situation.
B. There is significant difficulty in controlling the anxiety and worry. If someone has a very difficult struggle to regain control, relax, or cope with the anxiety and worry, then this requirement is met.
C. The presence for most days over the previous six months of 3 or more (only 1 for children) of the following symptoms:
1. Feeling wound-up, tense, or restless
2. Easily becoming fatigued or worn-out
3. Concentration problems
4. Irritability
5. Significant tension in muscles
6. Difficulty with sleep
D. The symptoms are not part of another mental disorder.
E. The symptoms cause "clinically significant distress" or problems functioning in daily life. "Clinically significant" is the part that relies on the perspective of the treatment provider. Some people can have many of the aforementioned symptoms and cope with them well enough to maintain a high level of functioning.
F. The condition is not due to a substance or medical issue
Case Examples of Anxiety:
Hillary, 23, experiences severe panic attacks whenever she is afraid she has failed or done something to anger a family member or coworker. Whenever she receives criticism, she begins to have trouble breathing, becomes sweaty, and may break out in hives. Her mind becomes completely focused on the offense she has committed, and she may cry, though she suppresses the tears and prevents catharsis. She drinks large quantities of alcohol to help numb herself to these feelings, and may miss work for days, which furthers her anxiety, as she has little income.
Bob, 45, is popular at work and very competent, feels highly anxious whenever he is out in public, especially around crowds. He races home each night, locks his door, and reads in bed, feeling fine once he is alone with the apartment secure. He cannot identify the cause of his anxiety, but in therapy discovers a great deal of repressed anger, which may explain his fear of being of being in public – people trigger his rage, which he has avoided for years.
Anna, 26, comes to therapy because of intense anxiety. Anna hasn't experienced a panic attack, but is often on edge, worried, stressed, and has a difficult time sleeping through the night. In therapy, Anna discovers that although a part of her wants to marry her fiancé, Jeff, another part of herself, which she has suppressed, is not in love with him. Identifying this internal conflict temporarily intensifies Anna's anxiety because now she has to face something she hasn't wanted face. Historically Anna has been a people pleaser. It's difficult for her to say "no" for fear of hurting other's feelings and then feeling her own guilt. Anna gains awareness about this and, through the process of unburdening her long-harbored guilt, Anna feels less anxiety others to feel pain. Although Anna hasn't yet decided what she's going to do about getting married, she feels less anxiety now that she is no longer suppressing her ambivalence and feels greater confidence about communicating how she really feels.
Therapy for Anxiety: There is a wide range of Psychotherapy Treatment Models or types of therapy used in the treatment of anxiety. Most of these approaches fall into three historic camps of psychology: Psychoanalytic / Psychodynamic approaches; Behaviorism and; Humanism. Regardless of the type of therapy, there are some generally agreed upon elements of "good therapy" which are universal to all forms of psychotherapy. Before beginning therapy for anxiety or any other issue, it is helpful to familiarize oneself with these elements.
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