Anxiety: Who’s in Control?
by Sabrina Trobak B.Ed., M.A.C.P.
August 20, 2011
This paper is a review of literature on anxiety; specifically focusing on types of anxiety, symptoms of anxiety, and therapeutic approaches for anxiety. Following this, is a look at how clients can take back their control when they are struggling with anxiety.
Types of Anxiety
According to the DSM IV (2000), anxiety can be mild or moderate or it can be severe. If anxiety is severe it is categorized and diagnosed into different diagnoses. Severe anxiety is diagnosed when a person becomes severely anxious without any real danger or reason for the anxiety and it affects daily living (Anxiety BC). Lagattuta & Wellman (2002) suggest that anxiety may be more of a spectrum of severe anxiety than diagnosed in specific areas. However, severe anxiety as defined by the DSM-IV-TR are specific phobias, agoraphobia, social anxiety disorder; often referred to as social phobia, generalized anxiety disorder (GAD), panic disorder, obsessive compulsive disorder (OCD), separation anxiety disorder (Sadock & Sadock, 2007) and post traumatic stress disorder (PTSD) (Anxiety BC).
Anxiety, at any level, is linked to both genetic and experiential factors (Sadock & Sadock, 2007). Sadock and Sadock state that it was possible there are abnormal genes predisposed to pathological anxiety states. The neurotransmitters norepinephrine, serotonin, and y-aminobutyric acid are all associated with anxiety (Sadock & Sadock). A significant difference between fear and anxiety is fear is a response to a definite, known threat and anxiety is a response to an unknown or vague possible threat (Sadock & Sadock). Fear has a rational base and anxiety is based more on irrational thoughts (T. Martens, personal communications, February 2009-April 2011). Sadock and Sadock also state 1 in 4 people meet the diagnostic criteria for at least one type of anxiety disorder with women at a higher rate than men. They also note that as socioeconomic levels go up, anxiety disorders generally decrease.
Whether a person has mild/moderate anxiety or severe anxiety there are similarities; all types of anxiety manifest themselves physically, mentally, and behaviourally (Anxiety BC). Those with anxiety disorders will experience similar symptoms as those with mild or moderate anxiety but will possibly experience more symptoms and the symptoms will feel much more intense and occur without a real danger being present (Anxiety BC). Mental symptoms of anxiety include worrisome thoughts, negative thoughts, pessimistic thoughts, critical thoughts of self and others, thoughts of potential harm, and believing negative outcomes are guaranteed (Anxiety BC). Some common physical symptoms of anxiety are rapid heartbeat, rapid breathing, stomach pain, stomach discomfort, nausea, feeling very hot or very cold, sweating, shaking or trembling, numbness, tingling, headaches, dizziness, light-headedness, feeling unsteady, chest pain or discomfort, lump in throat or choking sensation, and feeling of being unreal or detached (Anxiety BC, 2011). If many of these physical symptoms occur quickly and intensely, it is considered a panic attack (Anxiety BC, 2011).
Behavioral symptoms of anxiety include, but are not limited to, seeking reassurance, and perfectionism (Anxiety BC). FORCE Society for Kids Mental Health (2008) goes to explain that children with anxiety may often be absent from school, have a decline in grades or inability to work to their potential, cry for little or no apparent reason, fear new situations, be reluctant to join in social activities, make claims of physical pains or illnesses without any apparent health problems, and may frustrate easily. BC Partners for Mental Health and Addictions Information (2003) adds anxiety may also cause the urge to urinate or defecate, blush, and tense muscles. Anxietycentre.com (2011) adds other behavioral symptoms as well including, depression, dramatic mood swings, difficulty falling and staying asleep, bad dreams, jolting awake, uncontrollably harming of self or other loved ones, and fainting. Chewing fingernails, picking at skin, pulling hair or eye lashes or eye brows, and the urge to isolate oneself from others are also possible behavioral symptoms of anxiety (T. Martens, personal communications September 2010-March 2011) as well as self medicating with drugs, alcohol or food, compulsive behaviors, and mental rituals such as repeating a certain phrase or action (Newth, 2003) . One of the most common behaviors a person uses to deal with anxiety is avoidance but this behavior is the main cause the anxiety will continue and may actually increase anxiety levels as well (Anxiety BC, 2001). In order for a person to overcome anxiety around a certain behavior or situation the person must face that behavior or fear rather than avoid it.
Watt, Steward, Moon, & Terry (2010) found that positive or negative reinforcement for physical illnesses, aches and pains are related to childhood learning experiences which are also related to anxiety symptoms.
Sadock and Sadock (2007) state the IDC-10 criteria for a specific phobia as:
• either a marked fear or avoidance of a specific situation.
• symptoms of anxiety as defined in agoraphobia: at least one of the first 4 symptoms, felt on at least one occasion; heart rate increase, sweating, trembling or shaking, and dry mouth.
• A person must also experience at least one of the following as well; difficulty breathing, choking, chest pain or discomfort, stomach distress, feeling dizzy, faint, light-headed, sense of the situation being unreal or that self is distant, fear of losing control, fear of dying, hot flushes or cold chills, and numbness or tingling sensations.
• avoidance or the symptoms cause significant emotional distress which the client recognizes as unreasonable or excessive.
• the symptoms only occur during the feared activity or when contemplating the feared activity.
• the fear is not a result of any other mental illness, delusions or hallucinations.
There are a variety of different therapeutic approaches to help alleviate anxiety. Research suggests that both behavioral therapy and cognitive therapy are effective models for helping clients struggling with anxiety (Varley, Webb & Sheeran, 2010) . There is increasing research suggesting cognitive-behavioral therapy (CBT), the combination of both cognitive and behavior therapy, aid in reducing both physical and mental anxiety symptoms (Domar, Clapp, Slawsby, Kessel, Orav 2000). Behavior therapy involves guided exposure through therapy sessions to the object or situation that is causing the fear (Wilson, 2008). Wilson states that this gradual exposure to the fear helps the client confront the fear of the situation and work through the symptoms. Wilson states that behavior therapy is not only effective with anxiety disorders but also with more complex disorders such as panic disorder and OCD. Cognitive therapy assumes psychological distress is caused by a number of factors and emphasizes the importance of information processing and adaptation (Wilson). Cognitive therapy teaches a variety of different mental or thinking strategies a client can implement to help reduce or cope with stressful situations that cause anxiety (MacLaughlin & Hatzenbuehler, 2009).
The amalgamation of behavior therapy and cognitive therapy was a very powerful hypothesis (Zimmermna & Schunk, 2003). Cognitive-behavioral therapy is an evidence based treatment for anxiety recommended by the Anxiety Disorders Association of BC (ADABC) and focuses on decreasing patterns of behavior that worsen the symptoms of anxiety and increasing the patterns of behavior that reduce anxiety symptoms (Newth, 2003). In CBT clients are encouraged to talk about negative emotions during a calm conversation before or after an anxiety provoking activity or to talk during situations that allow children to learn how to manage their emotions (Lagattuta & Wellman, 2002). According to McLaughlin & Hatzenbuehler (2009) anxiety sensitivity involves negative affect and distress and that stressful life events trigger the development of these thought processes.
Lagattuta & Wellman (2002) found that often adults lead conversations around emotions making it easier for children to discuss their emotions because they can follow what is suggested rather than figure it out on their own. They go on to state that it is more beneficial for children to interact with siblings or peers as this promotes and encourages the child to communicate an understanding of emotions on his/her own.
Who’s in Control
As a therapist, clients will often tell me they feel anxiety controls them and they are powerless to fight against the anxiety. Many clients state that the feeling just comes over them or overwhelms them, like a cloud over their heads, and there is nothing they can do about it. This is not true. The feeling of anxiety is created by the thoughts a person has. If a person is feeling anxious it is because of the thoughts he is having. Previously Lagattuta & Wellman (2002) stated people must learn to manage their emotions. They do this by first recognizing and then managing their thoughts. If a person is thinking about not getting dinner ready in time, why aren’t the kids home yet, the partner will be late again, and there is no time for self, chances are the person will start to feel irritated, anxious and resentful. However if the person thinks, he is glad to get out of work earlier enough to make dinner so it isn’t too late, how peaceful it is in the house before everyone is home and expect that the partner maybe late but will be glad to have a plate waiting will create different emotions, such as contentment, and calmness.
As a therapist, my goal is to help clients realize they are in control of their own thoughts and therefore are in control of their own feelings and can then control their anxiety. In working with clients we review previous life experiences when they felt anxious and talk about what they were thinking when they were feeling anxious. I then go back and discuss other ways the clients could have thought about the situation to reduce their anxiety. Slowly clients start to understand they are in control of their thoughts and their thoughts control their feelings.
Often clients feel overwhelmed and struggle with thinking different, more helpful thoughts and then struggle with anxiety. It is important to remember that reframing one’s thinking takes practice and doesn’t just happen. A very useful strategy for dealing with thoughts that are creating anxiety is counting backwards from 100. When a client is thinking thoughts that are creating anxiety, and is unable to think of more helpful thoughts, counting backwards from 100 stops the unhelpful thoughts. The brain cannot count backwards from 100 and think unhelpful thoughts so the unhelpful thoughts stop. If these thoughts stop, the feelings created by these thoughts also subside.
While there are many different symptoms and types of anxiety, as well as many different therapeutic approaches, to effectively deal with anxiety a client must learn to control his own emotions by controlling his own thoughts. Once there is the realization that anxiety doesn’t happen to him but is an emotion he creates he will be able to take control of his thoughts and emotions. When he understands he has the power to change his thinking and then change the emotions, he will understand that he is responsible for creating his own anxiety and reducing his anxiety as well as controlling all his other emotions.
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