Archive | Anxiety

Living With Anxiety – Patient Stories

What does it feel like to live with the anxiety? For some people, it’s never-ending worry.  For some it’s panic in certain situations, while for others it’s like listening to a recurring audio loop of doom and gloom.  As the following stories illustrate, whatever the form of anxiety, there are tools that can help people manage their symptoms constructively.

Coping with Anxiety – Changing the Tape

Bonnie, a fifty-year-old woman with a sunny personality, has dealt with anxiety off and on since adolescence.  For her, anxiety manifests as catastrophizing a situation and imagining worst-case scenarios. Her heart races and her thoughts feel like they are running amok.  When she feels this way, and seems to be having an outsized reaction to a problem, her husband often reminds her to “back away from the cliff.”  Then, she changes the tape and reminds herself that she doesn’t want to expend her energy worrying about something that may never happen.  Instead of asking “What if?” and imagining the worst, she will challenge herself to imagine “What if….” everything turns out okay.

For Bonnie, one of the effects of living with anxiety is that it causes her to back away from social situations.  She’ll avoid making plans and will spend more time alone, even if that’s not what she really wants. Bonnie laments time she has lost enjoying her life and the people in it due to anxiety. She doesn’t want to miss out on further experiences, so she does everything she can to mitigate anxiety’s impact.

Therapy and Support Groups Can Be Helpful for Anxiety Sufferers

Bonnie has found working with a therapist and joining a support group to be helpful.  She is now able to employ strategies to manage her anxiety symptoms.  For example, when a worried or unhelpful thought pops up, she says, “Cancel.  Cancel.”  This helps her interrupt those thoughts and replace them with positive self-talk (“It’s okay. I can handle this.”).

She has also found that being open to serendipity can be an unexpected support.  Coming upon a kindness rock with just the right message, or an online quote, can help bolster her intention to stay ahead of her anxiety.  A while back, she salvaged an assortment of wooden letters at work.  Later, a few of the letters got tossed in a box that she brought home.  From the original assortment three letters remained: “c” “A” and “n.” Bonnie placed them together on a shelf and leaves the message “cAn” undisturbed, a reminder that she can overcome her negative thoughts and can experience life on her terms.

Because she has learned some hard-won lessons, Bonnie was eager to share her experience with others.  In addition to working with a therapist, Bonnie cites the healing power of nature and physical movement to calm her thoughts.  She wants others suffering with anxiety to know there is hope and that change is possible.

Childhood Anxiety

Living with anxiety isn’t reserved for adults. Talia’s daughter, Hannah, was diagnosed with acute anxiety disorder as a young child.

By the age of three or four, Talia and her husband knew that Hannah had a tendency to worry.  Hannah bit her nails, had heart-breaking difficulty being weaned from a pacifier, and always seemed to need an object to fiddle with in her hand or her mouth.  Hannah cried when a picture she colored wasn’t “perfect.”  She cried when it was time to ride the bus to kindergarten, needing to sit behind the bus driver every day.

Early on, these behaviors, while difficult, didn’t seem to her parents to be cause for undue concern. After all, lots of children have a hard time letting go of their pacifier and are afraid to ride the bus. Yet, when Hannah, finding herself without something to fiddle with or chew on, got her hands on some broken glass and began to chew it, her parents knew they needed professional help to address their daughter’s needs.

As Hannah grew, her anxiety worsened. In first grade, Hannah worried about her performance in school.  While studying for spelling tests, she would become so worried about disappointing her teachers and parents that she pulled clumps of her hair out of her head.  She had paralyzing fear in new social situations, avoided making eye-contact and found making friends difficult.

After having Hannah evaluated by a neurologist, Talia brought Hannah to a psychiatrist for weekly appointments. When Hannah was younger she couldn’t put into words the thoughts that caused her anxiety, but the psychiatrist helped Hannah voice these thoughts.  For example, when Hannah cried about getting on the bus for school, it wasn’t because of shyness or fear of the bus itself. Her real fear was that if she rode the bus, something bad would happen to her parents.

What to Do When You Worry Too Much

Talia credits a series of therapists and teachers with helping Hannah learn coping strategies.  One professional recommended the book, What to Do When You Worry Too Much by Dawn Huebner, which is organized in workbook fashion.  Talia and her husband worked through the activities with Hannah and learned such techniques as confronting your “Worry Bully.”  Your Worry Bully sits on your shoulder and says things like:

  • “You’re not good enough.”
  • “If you do (or don’t do) that, something bad will happen.”
  • “What if you make a mistake?”
  • “You’ll be in trouble if….”

Hannah is learning to recognize when anxious thoughts are coming from her Worry Bully.  She was pleasantly shocked when her parent said she could tell her Worry Bully to shut up- a turn of phrase otherwise not allowed in their home.

Another technique Talia says helps her daughter is to think of her anxiety like a tomato plant.  If you feed and water a tomato plant and give it lots of attention, it will get bigger.  If you give your anxious thoughts attention, that allows them to grow bigger, too.  When Hannah starts becoming anxious her parents ask whether she’s “feeding” her anxiety and what she can do to stop.

Hannah, now almost twelve, has made great progress. Whereas in the past complete meltdowns were a daily occurrence, now they occur only once or twice a month.  Hannah still worries about her performance in school, but cries less when she makes a mistake. Her therapy sessions are down to once a month.  She is able to practice self-care when needed.  When her thoughts start to get the better of her, she will say to her family, “I’m not okay, right now,” and head to her room.  She reads or writes in one of the many notebooks her parents have provided for her.  She reminds herself to take deep breaths.  She knows now that the anxious feeling is temporary and that the moment will pass.

Talia expresses frustration that anxiety, which is so common, is often an unspoken struggle.  Like Bonnie, she wants to share her family’s experience because she hopes others will feel less alone reading their story.

Then, there is Josie.  A forty-something mother of three, Josie never experienced anxiety in her younger years.  Even after a diagnosis of Type I Diabetes in her teens, Josie didn’t worry too much about her health or future complications from her disease.  It wasn’t until she lived through three extremely high-risk pregnancies and life-threatening asthma episodes that she realized things “can go wrong” and began experiencing panic attacks.  During one pregnancy, she developed Proliferative Diabetic Retinopathy (PDR), which causes blindness.  Correcting the PDR required a year of multiple eye surgeries and other painful procedures.

Driving is often fraught with worry for Josie, especially when her children are in the car.  Understandably, she worries that while she is driving she may have an insulin reaction or an asthma attack.  The idea of driving with her children on the highway is frightening, so she avoids it.  One day, she tried to push aside her worries to take them clothes shopping only to have panic set in.  Ultimately, she had to pull off the highway to collect herself and return home on backroads.

Although Josie’s anxiety began because of specific concerns about her health, she also experiences a more generalized anxiety.  For example, when summer comes she is plagued by dreams of her children drowning.  She does not allow her husband to drive all three of her children in the car simultaneously, for fear she will lose her whole family in one hapless moment in the road.  Similarly, driving together as a family causes her intense fear.

Breathing Techniques to Manage Anxiety

Like Bonnie and Hannah, Josie has learned what helps her manage the symptoms of anxiety.  Focusing on her breath and positive self-talk help her when she finds herself beginning to panic.  She tells herself that even health flare-ups are temporary and she is more than her illness.

Josie wards off anxiety by remembering positive comments from her doctors and repeating them to herself like a mantra.  When she’s feeling particularly worried, her husband will soothe her with those same words as she’s falling asleep.  Josie also sings in a musical group and gives hours-long performances, which are immensely healing for her. In her words, it’s one way of saying, “Let me show you what I can do,” to her illness.

Anxiety Can Be Managed

Even though individual circumstances may be different, the symptoms of worry, fear, and imagining the worst are some of the hallmarks of anxiety.  Bonnie’s or Josie’s or Hannah’s story may sound familiar.  Each of them has felt that their anxiety was unmanageable, would never end, and that they were doomed to always be at the mercy of their thoughts.   Each has learned that none of that is true.  Anxiety can be managed and each incidence will pass.  There is hope and help is available.

References

Stewart, Laurie M., “Negative Self-Talk: Stop the Tape!” September 2010.
http://www.valueoptions.com/solutions/2010/09-September/story4.htm
http://thekindnessrocksproject.com/

Suttie, Jill.   “How Nature Boosts Kindness, Happiness and Creativity,” March 11, 2016.
https://www.mindful.org/how-nature-boosts-kindness-happiness-and-creativity/

Huebner, Dawn.  What To Do When You Worry Too Much: A Kid’s Guide to Overcoming Anxiety. Magination Press, 2006.
https://www.amazon.com/What-When-You-Worry-Much/dp/1591473144

Boyes, Ph.D., Alice.  “Breathing Techniques for Anxiety,” Psychology Today, July 12, 2016.
https://www.psychologytoday.com/blog/in-practice/201607/breathing-techniques-anxiety

Mindfulness Meditation Helped My Panic Attacks and Anxiety

For me, my anxiety always flares up when I get on a plane. I just can’t make myself do it. My palms sweat, and cold shivers run down my back. I feel my heart racing so hard I wanted to run. But in an airport – where can I run to?

When the Panic Hits

I know I’m not the only one. I know tons of other people go through this too. I also know it’s a feeling and it isn’t real, but when the panic hits, my heart beats so hard inside my chest I can’t think straight. I feel as if I can’t breathe, and the room is closing in on me. I feel as if the walls are moving and closer and closer, and I’m trapped.

Fear of Heights Anxiety

I never really had anxiety until I moved into my new apartment on the 12th floor of a high-rise. I hate heights; always have. But, I never thought it would bother me this much. Now, I’m afraid inside my own apartment. I’m constantly thinking: “What if I have to go on the balcony for some reason?” I keep the curtains closed, because I can’t deal with how high up I am. I’ve told the landlord I need a lower apartment, but that might not happen.

Fear of Flying Anxiety

I’ve just been told I need to travel more for my work. But, I hate taking planes. I don’t like the thought of being up in the air like that, and all I can think of is what if the plane crashes? I sit in my seat and shake. Even though I shouldn’t, I either take a sleeping pill, or have a few drinks. Doesn’t solve the problem, but I don’t know what else to do.

You know how some people have one of those families where everyone is anxious? That’s my family. I remember my father being this nervous sort-of fellow who fell apart at the least problem. Then, when he got anxious, he would make all of us anxious too. He would scream and terrorize everyone else until he calmed down. Now, all these years later, I find myself doing the same thing. I don’t know why, but the least bit of stress causes me to panic. Maybe I should go to the doctor, but I don’t want to take a bunch of pills. Who knows what those things do to you? A week ago, I was in the store with my teenage daughter and the panic hit me. I dropped my purse and my packages and ran out as fast as I could. I couldn’t take it in there. One time, I even fainted. My heart feels like it’s soaring out of control and will burst out of my chest. I know that isn’t logical, but it’s how I feel in the moment.

Panic Attacks Prevent Me From Leaving House

Anxiety and panic attacks have really become a huge problem for me. I avoid people, situations, and places I know will upset me. For the most part, I don’t even want to go out of the house. Maybe it isn’t normal; I don’t know, but I can’t face the outside world. I order all my groceries, and I don’t get together with friends anymore. Inside my apartment, I feel relatively safe, but I can’t go outside. I just can’t.

The first time I had a panic attack my legs felt as if they’d turned to jelly. I started hyperventilating. I don’t understand it, but I began to feel really small and vulnerable, as if I was in a dream I couldn’t wake up from.

When I get these attacks my head feels foggy for hours, sometimes even several days. It’s like I can’t organize my thoughts.

When it hits me, I get this weird prickly feeling in my chest, my throat feels tight and sore, and I just want to jump right out of my skin. Everything about me feels desperate and I can’t get enough air into my lungs. It’s as if my mind knows something’s wrong, but my body has no clue what to do it. Sometimes, I get so nauseated I want to vomit. Then, there are those times I’m dizzy and light-headed, and I feel as if I’m going to faint.

One night when it was late and I was getting ready for bed, the panic hit me. I thought I was going to die. Dozens of thoughts kept flooding my brain all at once. Everything felt around me felt wrong, but I didn’t know why. I totally felt as if I was fighting some sort of monster trying to hurt me. My body got weaker and weaker until these waves of cold washed over my body. It was terrifying!

Mindfulness Meditation Has Eased Anxiety

I know that a little bit of anxiety is normal. My therapist has told me that. She went into this big speech about how it’s all very primal from way back when our ancestors were climbing out of trees. How does that help me? I’m not in the trees, and I don’t live back then. But, when the attacks hit me, it’s this fight or flight response that floods my body. I know it’s only my brain telling me I’m under attack, but it feels so damn real.

Anxiety is the response to a perceived threat. Even if the threat isn’t real, the body believes it to be so.

Recently, I decided I needed to do something about my panic attacks. My doctor suggested mindfulness meditation. So, I looked it up on the Internet, and I decided it was worth a try. I’m grateful I did it because it has really helped. Mind you, it didn’t help right away; it took some time and I really had to practice it. But, I find that if I keep up the meditation practice, I don’t get the panic attacks anymore, and my anxiety has gone way down. Feels great!

My doctor told me that one of the things I could do for myself is get a regular routine of deep sleep. Let’s face it, we live in this busy, highly technological world, where we’re constantly connected to our televisions, our laptops, and our cellphones. Now, I turn everything off at least an hour or two before I go to bed. I’ve developed this habit of shutting out the world, making my room a calm, quiet place to be, and it’s really helped. I sleep so much better, and my anxiety has gone way down. Who would have thought such a simple solution could be so helpful?

See the companion article to understand more about anxiety, and resources to help you.

Personal Perspective – Anxiety

Can a little bit of anxiety do us good? That’s the question that Eleanor (name changed for confidentiality) asked herself. After years of therapy she found the severe and crippling experiences lessened and she could start to question their existence in the first place.

It’s one of the paradoxes of life. Sometimes the very things that are making us feel bad can also be of benefit. Scientists have studied the genetics of anxiety, depression, eating disorders and other mental illnesses and found that often they developed as evolutionary responses to difficult or stressful situations. An anxiety disorder per se is not of use, but certain symptoms of them can be.

Embracing Anxious Feelings

What if, rather than fight anxious feelings, we were to embrace them? It’s difficult to be gleeful about things that are causing us difficulty, but by flipping our attitude it might be possible to not only accept the emotions, but actually use them for our benefit. Reverse psychology, if you will. Rather than panic and get more anxious about our levels of anxiety, we can start to think about how feeling anxious can help us.

‘I remember its purpose,’ says Eleanor. ‘Anxiety is there to keep us safe. When I remember why I’m feeling panicky, I’m able to breathe more deeply and calm myself down.’ Anxiety is useful to us as it tells us that something is potentially risky, and we need to be careful. If you’re able to use your rational mind to calm any extreme anxiety, and find that you still feel nervous or worried about something, perhaps it just isn’t right. That gut instinct can be powerful. ‘I remember when I was trying to choose a school to go to. For some reason every time I thought of one in particular my heart would race and I could feel my anxiety rising. I decided not to go, and ended up having a great time at the one I did go to. I learned later that there were lots of staff shortages and teaching was bad. Maybe my anxiety kept me safe from a bad school!

Researchers from the Baruch Ivcher School of Psychology in Israel have found that those demonstrating higher than average levels of ‘attachment anxiety’ are not only great at keeping themselves safe, but other people as well. This even extends to spotting liars and protecting us from heartbreak, as Ein-Dor and Perry found.

Eleanor has always been quite a high achiever, and thinks that one of the reasons for this is the effort she puts in to performing well, often as a result of some anxiety. If you’re nervous about an exam, or concerned about performance at work, feelings of anxiety can help motivate you to revise or put in extra effort. ‘The fear of performing badly can make us undertake action to ensure that it doesn’t happen,’ she says. ‘When I was younger it was probably too much and I would stay up all night revising, but now I am really strict and just put in an extra hour on a project or preparing for a meeting.’ Whatever the worry, the anxiety that is created can often push us to do something about it.

Social Phobia and Heightened Sensitivity to Others’ State of Mind

‘I’m really sensitive, but I’ve learned not to let it overwhelm me, and to enjoy the sense of being perceptive and attuned to other people and my environment. I think that people with anxiety are often more empathic and can build better relationships,’ Eleanor says. Anxious people tend to be more sensitive to stimulus. They pick up physical and emotional signals, and have been shown to show ‘sensitivity and attentiveness to other peoples states of mind.’ This is clearly a good trait. A study published in the Journal of Psychiatry indicates that ‘individuals with social phobia show sensitivity and attentiveness to other people’s states of mind.

Making decisions is hard for Eleanor, but she can’t deny that they are well thought through.  ‘I can’t decide anything quickly. I go over and over the pros and cons in my head. It used to drive me mad (pardon the pun) but now I recognize that this can be a good quality to have.’ Some scholars have argued that anxiety makes us better voters because it changes the way we process the news. Rather than focusing on just the positive, we weight up both sides of the argument and make more rational and well thought out decisions.

So, would Eleanor say that all these ‘positive’ aspects are worth the anxiety? ‘No. I lost many years being completely debilitated by panic attacks and overwhelming anxiety. It’s only now that I have the severe symptoms in check that I’m able to acknowledge some of the qualities that perhaps make me more susceptible to anxiety issues, and recognize how I can use them in a positive way.’ Of course no one wants to feel anxious, and an anxiety disorder is a horrible illness with severe implications. But opening up to potential benefits of some of the feelings can help. Positive thinking won’t make anxiety go away, but it can help to take the edge off some of the tough times.

Anxiety

Anxiety a Leading Reason for Therapy

Anxiety and related conditions are the leading source of unease and suffering that brings people to therapy. The severity and duration of anxiety can fall on a continuum from mild and quite manageable with or without psychotherapy to extreme to the point of a near total inability to function.

Tendency to Anticipate Danger

Our brains are wired for and have evolved to perceive immediate and serious potential threats. There are evolutionary reasons for the human tendency to anticipate danger and to fear for our survival. Three different parts of our brain create a triune of reactions that have remained part of the human psyche long past the time when humans had clearer threats, such as being harmed by a wild animal. The brain causes us to have rational, emotional and instinctive reactions to danger. As a result, not only threats to our lives can elicit powerful anxiety and fear reaction.

Existential Threats Which Provoke Distress

Humans of the 21st century typically, of course, live lives far removed from those of our distant ancestors but we share nearly the same brain and eons of evolution with survival being the predominant requirement. In our modern world, direct threats to our physical well-being may be diminished, but we still regularly experience setbacks such as perceived sleights, failures, troubled relationship, family conflict, loss of a job, perceived diminished social standing, or lack of meaning and connection in life, as an existential threat which can elicit enormous levels of distress and suffering. As a result, not only threats to our lives can elicit powerful anxiety but also our lives can feel as though we are facing existential threat on a regular basis and this of course is a deeply painful experience. This is in many ways the essence of most anxiety disorders

The Natural Tendency to Escape from Anxiety

As humans who wish not to suffer, it is normal and understandable that we seek to escape these anxiety producing feelings as quickly as possible. The trouble is that we often try to escape in ways which are of limited use, or even which make things worse. Some of the ways in which we seek to escape the painful feelings of anxiety include suppression or denial of painful feelings, diversion and inability to focus, obsession with other activities, such as work or exercise, television or video games, or problem use of drugs, alcohol, gambling or sex.

It is important to understand that the tendency to want to escape from anxiety doesn’t indicate a moral failing or a personal weakness. It is perfectly human to seek to escape by any means necessary from that which we perceive may destroy us. What is needed are new tools and methods to live with our distress, to be able to pursue and experience our lives as meaningful and to be able to find and experience periods of joy and contentment, in spite of the distress of anxiety. As a byproduct of this, we will often find that the anxiety severity and duration can abate and make space for other experiences and feelings which we may find much more satisfying and hopeful. d It is through such processes as psychotherapy and mindfulness based meditation in which the foundation of real change and progress can be begun.

Relationship between Fear and Anxiety

Anxiety disorders include those that share features of excessive fear and anxiety. Fear is the emotional response to real or perceived imminent threat. Anxiety is the anticipation of future threat.

The states of fear and anxiety overlap, but there are differences. Fear often initiates the fight-or- flight response due to thoughts of immediate danger and escape. Anxiety is more of a vigilance in preparation for future danger, initiating cautious or avoidant behaviors that cause muscle tension.

Types of Anxiety

Here are some of the most common forms of anxiety:

Agoraphobia: Fear of being in large or unknown public places, often associated with panic attacks. This phobia may cause a person to fear leaving home. This may be connected to a troubling or traumatic experience, and often in therapy, the reason for this fear may surface and allow the person to develop strategies that allow a more ordinary coming-and-going.

Free Floating or Generalized Anxiety: A chronic sense of doom or excessive worry that affects a person almost daily, lasts for six months or more, is difficult to control and does not seem to be attached to a specific issue or concern. Some symptoms include fatigue, restlessness, irritability and sleep problems.

Obsessive Compulsive Disorder: Recurring, unwanted thoughts or obsessions along with repetitive behaviors or compulsions. These behaviors might include hand washing or repetitive checking on things, for instance, whether the stove is turned off.

Panic Disorder: Unexpected and repeated episodes of intense fear accompanied by physical symptoms that may include chest pain, heart palpitations, shortness of breath or dizziness.

Post Traumatic Stress Disorder: Anxiety that develops after exposure to a terrifying event, such as military combat, a personal assault or a natural disaster.

Social anxiety: Excessive self-consciousness or fear in one or more social situations, such as public speaking, or in more generalized cases, anxiety from being around other people in many types of situations.

Options for Treating Anxiety

The two main treatments for anxiety disorders are psychotherapy and medication, and sometimes a combination of the two.

Psychotherapy, also called talk therapy or psychological counseling, with a qualified professional is an important first step to get an accurate diagnosis and plan a course of treatment.

Cognitive behavioral therapy, or CBT, has been shown to be a highly effective form of psychotherapy for anxiety disorders. CBT focuses on learning specific skills to use in situations that may cause anxiety.

The proper treatment can lessen the severity and duration of anxiety and make space for other experiences and feelings that are more satisfying and hopeful. Often with anxiety, even a little progress can be very meaningful, as it can provide a path to a different and better way to experience our lives.

Research and experience has shown that processes such as psychotherapy and mindfulness-based meditation can be the stepping stones to change and an increased sense of optimism and hopefulness.

New Insights on the Nature of Anxiety

We are only beginning to more deeply understand that what distinguishes our species is our ability to contemplate the future. Martin Seligman, a leading expert on “positive psychology,” said in a New York Times article that, “Looking into the future, consciously and unconsciously, is a central function of our large brain, as psychologists and neuroscientists have discovered, rather belatedly, because for the past century most researchers have assumed that we’re prisoners of the past and the present.”

Seligman said this future orientation creates optimism in some people, while “… those suffering from depression and anxiety have a bleak view of the future, and that in fact seems to be the chief cause of their problems, not their past traumas nor their view of the present.” The human tendency to anticipate, combined with an over-estimating future risks, can cause anxiety.

It is one of the paramount goals of our practice to work assiduously and collaboratively with our clients to help them uncover their inherent strengths and resilience and to enhance and build on them to create meaningful and lasting positive change in their lives. As this work progresses, anxiety can evolve from a defining quality in  one’s life to a more transient and diminished thought construct and feeling leaving space for other more positive, engaging and optimistic thoughts and feelings to take a more central role in one’s life.

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References

Diagnostic and Statistical Manual of Mental Disorders, DSM-5, American Psychiatric Association, Oct. 1, 2016
https://www.psychiatryorg/psychiatrists/practice/dsm

Price, John S., “Evolutionary Aspects of Anxiety Disorders,” National Institutes of Health, September 2003.
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3181631/

National Institutes of Health, “Major Types of Anxiety Disorders,”
https://www.hhs.gov/answers/mental-health-and-substance-abuse/what-are-the-five-major-types-of-anxiety-disorders/index.html

News in Health, “Understanding Anxiety Disorders: When Panic, Fear and Worries Overwhelm,” National Institutes of Health, March 2016
https://newsinhealth.nih.gov/issue/mar2016/feature1

Seligman, Martin and Tierney, John, “We Aren’t Built to Live in the Moment,” New York Times, May 19,2017.
https://www.nytimes.com/2017/05/19/opinion/sunday/why-the-future-is-always-on-your-mind.html

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