Treating Anxiety and Panic
When clients seek treatment with me for anxiety I tend to keep a very open mind while we explore their concerns, for three main reasons. First, anxiety disorders and their chief symptoms are broad and varied. Second, anxiety manifests differently in everyone. Third, anxiety manifests at many levels – thoughts, feelings, behaviors, and body sensations. I tend to:
- Explore with clients the nature of their anxiety – is it generalized, is panic involved, is it mainly social, a phobia, or obsessive thoughts or compulsive behavior? Did my client have a trauma history? I would also find out when they first recognized that they were affected by anxiety, and what situations, events, things, or people trigger it, or what may make it worse. I may ask them to track how they feel during the week to assist with this process of exploration.
- Use a psychodynamic lens to reflect on their developmental histories and determine if patterns of interaction or expectations in their family of origin may have contributed to their anxiety.
- Use a combination of cognitive restructuring and body-based techniques. While I believe it is vital to “challenge” my clients’ amplified appraisals of danger and threat and their own helplessness as well as exaggerated perception of consequences and help to replace these with more realistic thoughts, I adhere to the maxim that fear is held in the body. I would use deep breathing to slow down the nervous system, safe place and strengthening imagery, progressive relaxation, basic mindfulness meditation, and principles of SE described in the video below, which have been very effective. Once my clients are in greater control of their bodily responses to anxiety, the two-way “feedback loop” between body feelings and thoughts (e.g., “my heart is pounding and I’m short of breath – I MUST be having an anxiety attack”) becomes less powerful.
- Recommend a careful use of Exposure Therapy to help desensitize my clients to the event or situation that has made them fearful and avoidant. I have a strong belief that we can change our thoughts and calm our overactive nervous system when we realize that we are not now in danger. I would focus first on reinforcing strengths and inner resources. I would then collaborate with them to determine the safest possible way to do this, including a safe person such as a close and trusted friend or relative, or, if my client wishes, even myself. I would likely start with imagining exposure first.
- I would also stress many of the holistic approaches I listed under treatment for depression, particularly a consideration of my clients’:
- Exercise level – exercise is known to release a calming neurotransmitter called GABA, and to actually change the structure of the mammalian brain, which may help us recover from stress much more quickly.
- Sleep patterns – sleep deprivation has been shown to heighten anticipatory anxiety, since it amplifies the activity in parts of the brain which underlie emotional processing such as the amygdala.
- Use of alcohol, tobacco or other substances to reduce anxiety, which often masks symptoms and can even make them worse and can eventually cause addiction.
- Nutrition – my clients are often surprised to hear that something as simple as going without a well-rounded breakfast that would keep their blood sugar up during the day can prevent symptoms, like shakiness, weakness and dizziness that mimic panic!
For additional information, see the websites listed above or additional sites under the “Helpful Links” tab.