Anxiety: You Can Handle It

I am seeing a lot of anxiety in my counseling practice. Fear is a normal aspect of life in a world in which we all have experienced that bad things can happen to us. Without faith, it can become a serious detriment to functional living. And even people of faith experience anxiety, sometimes to the degree and in ways that cause them to feel guilty or doubt their faith. We don't understand everything, of course, about anxiety, but we know that some of the older, more primitive, fight, freeze or flee parts of the brain are active when anxiety is being experienced. Here is an example from my life: I was lying on the sofa, almost asleep, when something outside startled my little dog, Axel, who was also on the sofa with me. His loud, high-pitched barking startled me and I bolted upright on the sofa, prepared to fight or flee. Adrenaline was pumped into my bloodstream and my heart rate shot up. I did not have to think about this reaction any more than I have to think about breathing or blinking my eyes--it was instantaneous and automatic. This is the "old", primitive brain, geared for survival. In seconds I realized what was happening. "Oh it's Axel. He barks at everything from raccoons to people walking down the street." Those thoughts came from my frontal lobes, the more evolved part of my brain, where wisdom, worship, logical thinking, foresight, appreciation of beauty, etc. reside.That part of my brain sent a signal to the "older" brain that everything was OK. "We could 'all' relax." I laid back down and resumed my nap, though it took a few minutes for my heart rate to slow back down. In people who have been in war zones or suffered prolonged exposure to traumatic stimuli, or in some people for unknown reasons, this cycle of communication between the "old" and "new" brain doesn't work very effectively. The old brain just doesn't seem to get the message that everything really is OK. The fight, freeze or flee dynamic stays active at a higher level than necessary for safety and survival. The challenge then becomes to train ourselves to relax through increased conscious effort. We must fortify our higher consciousness, the frontal lobe activity, reminding our self through powerful affirmations that all is well; and training our body to relax through certain techniques--meditation, prayer, deep breathing, visualizations, etc. All of us, whether we suffer from excess anxiety or not, need to be reinforced in the "peace of Christ that transcends understanding." [Philp. 4:7]. We all need to hear very deeply and receive Jesus' command to "Fear not, and let not your heart be troubled" [Jn. 14], and trust, at the cellular level, that God is working all things together for good [Rom. 8:28]. I think it's fair to say that no one has discovered the depths of peace that are available to us. We can all grow into a deeper peace than we have known, no matter how long we have been in Christ. For some, this is the primary challenge to their growth in Christ. Let's always remember that "greater is He that is in us [the Prince of Peace] than he that is in the world [the source of fear]" [1Jn 4:4]. May the peace of Christ dwell in you deeply, and His love in and through you drive out all fear. In His Holy Name. Amen "Anxiety never releases tomorrow of its problems;it only empties today of its strengths." Corrie ten Boom [Holocust survivor] "Anxiety is a fear that refuses to respond to faith." Don Baker, Thank You Therapy, Victor Books, p. 14. "Anxiety focuses on self and has its roots in unbelief. Peace focuses on God and has its roots in faith." Baker ibid p.? Fears may be rational or irrational. An irrational fear is one which, aside from itself, represents no danger. That is, if an irrational fear is put aside or ignored, there is no danger that can be clearly seen. The fear itself is the only problem. In most people who have a problem with fear, rational and irrational fears are mixed together in such a way as to make it difficult for them to clearly see the irrational part of the fear. And indeed even if they do see, they often do not let go of it right away. It is as if they "see" it on a very shallow level of perception at first, and the "seeing' has to sink, over time, down into a deeper level before affectual relief is experienced. "Perfect love casteth out fear." "The fear of the Lord is the beginning of wisdom." "Do the thing you fear, and the death of fear is certain."  R. W. Emerson

Fear knocked on the door.
Faith opened it.
No one was there.

"Twas grace that taught my heart to fear
And grace my fears relieved." John Newton, hymn "Amazing Grace"

We are not created to live with fear of what is inside ourselves.

Without the commitment to love, fear is an important, healthy motivator; necessary in guarding against apathy, laziness, and entropic drifting.  But "perfect love casteth out fear."  As we grow in Christ, as we are being sanctified, Love is replacing fear as our basic motivating force.  In other words, as we grow in Christ, we do the things we do less and less because we are afraid not to, and more and more because we want to make our lives an expression of the Love of Christ.  A good question to ask ourselves periodically is:  How much of what I do is done for fear of not doing it, and how much is done because of willfully chosen love?



WHEN I HAVE FEARS THAT I MAY CEASE TO BE


When I have fears that I may cease to be
Before my pen has gleaned my teaming brain,
Before high-piled books in charac'try
Hold like rich garners the full, ripened grain;
When I behold upon the night's starred face
Huge cloudy symbols of a high romance,
And think that I may never live to trace
Their shadows with the magic hand of chance;


And when I feel, fair creature of an hour!
That I shall never look upon thee more,
Never relish in the faery power
Of unreflecting love; -- then on the shore
Of the wide world I stand alone and think
"Til Love and Fame to nothingness do sink.

John Keats



The world system is fueled by fear.  Do you work because of fear or love?  Why do you so tediously keep all your ducks in a row?  Yard trimmed so neatly?  Accounts up to date?  Insurance policies in force?  Why are you so hypervigilant and competitive?  Is it because of love?  Or fear?

We also turn away from each other in fear.  Oh God!  FEAR!  How much we do and don't do because of fear.  Fear of being controlled.  Fear of losing control.  Fear of losing ourselves.  Fear that we might not be good enough.  Fear that we will fail our loved ones in some way.  Fear of the truth about ourselves.  Fear of looking deeply at ourselves, which we must do in order to grow - in order to love - in order to be free from the enslavement of fear.


Your fear is your ongoing reminder that you do not yet love enough.
The more you are motivated by love, the less you will need fear to motivate you.

My limitations are my fears that I have not yet overcome because I have not yet fully comprehended that my limitations are only my fears.  Perfect love destroys fear.

"He only is rich who owns the day, and no one owns the day who allows it to be invaded with worry, fret and anxiety."
Ralph Waldo Emerson



Anxiety is both a means by which a person may avoid his fears and the result of failure to confront and deal with fears.


"If we let things terrify us, life will not be worth living."
Seneca, Epistles

“He who fights against the future has a formidable foe.” [unknown]

Depend on God only
I am learning important lessons while on my journey to recovery.  My personality is one that makes me dependent on people who are close to me.  Over the years I have also developed a need for routine.  When my circle of friends or relatives is broken or the routine is altered, anxiety sets in and I generally feel terrible.  When I rationalize the situation I realize that my old thought patterns are trying to take control.  I become dependent on earthly things.  Absolute dependency on temporary, earthly things is counterproductive and has the potential to lead me down the wrong track.  What good does anxiety produce? Nothing! How good am I in overcoming this by myself?  I look at my past and realize I can do better. I am reminded of what Paul says in Philippians 4:6-7 "Do not be anxious about anything, but in every situation, by prayer and petition, with thanksgiving, present your requests to God. And the peace of God, which transcends all understanding, will guard your hearts and your minds in Christ Jesus."
    With anxiety, it's counterpart worry tends to emerge.  The words of Jesus offer a remedy to this when He said in Matthew 6:25-27, 34 “Therefore I tell you, do not worry about your life, what you will eat or drink; or about your body, what you will wear. Is not life more than food, and the body more than clothes? Look at the birds of the air; they do not sow or reap or store away in barns, and yet your heavenly Father feeds them. Are you not much more valuable than they? Can any one of you by worrying add a single hour to your life? Therefore do not worry about tomorrow, for tomorrow will worry about itself. Each day has enough trouble of its own."
      Perhaps God is trying to lead my thoughts according to the title of this note:  Depend on God only.  Throughout the rest of my life's journey I have choices when someone or something I depend on to give me comfort, peace and solace is not around and I get lost.  I can choose to allow my emotions take over and once again get lost in my journey.  I can find some medicine to take and let it do an artificial job of trying to quell the feelings or I can think about the real peace to light my pathway.  I'm becoming conscious of the truth that peace comes from God only.  Depending on God only offers the real cure.  Through Him there is an eternal peace that offers the only way through the quagmire of negative earthly thoughts that I have had for too long.  If I set my mind on things above I am following Paul's advice in Colossians 3:2 "Set your minds on things above, not on earthly things."
    I am thankful for friends, relatives and others for they offer me encouragement, and advice but they cannot me give me a permanent cure to the things that bother me.  They can offer advice but cannot be with me 24/7. Only God is eternal and can offer an enduring peace that will help me get through whatever trials and tribulations may come my way.

      This can be summarized in three bible verses that say God is faithful, trust in the Lord, submit to Him, and His word is light.  Together they offer a compass, map and strength to carry on my journey of recovery.

1 Corinthians 10:13 No temptation has overtaken you except what is common to mankind. And God is faithful; he will not let you be tempted beyond what you can bear. But when you are tempted, he will also provide a way out so that you can endure it.

Proverbs 3:5-6 "Trust in the Lord with all your heart and lean not on your own understanding; in all your ways submit to him,and he will make your paths straight".

Psalm 119:105 Your word is a lamp for my feet,a light on my path.
[David Lohmeyer]

Additional insurance of depending on God
Grace is my hope
What is your hope? This may seem strange to read at this point, but it must be said: the hope of your life isn’t all the principles, insights, and perspectives found in Scripture. No, the hope of your life can be captured in one glorious, powerful, and transforming word—grace. Without rescuing, empowering, forgiving, transforming and delivering grace, the principles of the Bible would only leave you discouraged and overwhelmed. God’s grace guarantees that you, in your struggle, will never be alone. God’s grace assures you that when you’ve blown it, there’s forgiveness to be found. Grace means that there’s strength available when you’re weak. Grace assures you that there’s wisdom for the moments when you don’t know what to do. Grace gives you hope when there seems little to be found. Grace enables you to get up and move forward when inside you want to quit or run away. Grace reminds you again and again that you’re not alone.
From Paul Tripp Ministries
Christianity.com devotionals

ANXIETY TIPS

• Anxiety tip #1: Notice and name. The first step is to identify your patterns. What specific triggers are linked to your anxiety? Notice what sets your anxiety in motion, and give it a name. Once you bring it into the forefront of your consciousness, you can begin to make sense of it and then to address it.

• Anxiety tip #2: Develop a plan. Many of us run ourselves ragged by not addressing our worries. One classic example: We’re afraid of getting breast cancer, but we don’t schedule the mammogram -- instead, we spin our mental wheels. Write your specific worry down, and then develop a plan to address it. Tackle one or two worries at a time. Once you’ve completed those, go on to the next on your mental list. This task-oriented process can give you a feeling of satisfaction; more importantly, it makes you feel less vulnerable, more in control of your life.

• Anxiety tip #3: Move. Exercise is one of the best self-treatments for anxiety available. It doesn’t matter whether you go for a walk, join a water aerobics class, dance, play tennis -- what does matter is that you get regular exercise, at least every other day. In the interim, whenever one of those cycles of ruminative worry hits, even simple activity -- minor housecleaning, a few minutes of gardening, some simple stretches, even just getting up and walking around for five minutes -- can help jog you out of that negative feedback loop.

• Anxiety tip #4: Breathe. A number of breathing techniques can alleviate anxiety. For one thing, many people find that when they’re anxious, they breathe shallowly, from the upper chest -- and when breathing is shallow and fast, the body responds with an increase in heart rate, blood pressure and stress hormones. In bad moments, they might even be holding their breath. Instead, take a few moments and simply notice your breathing patterns. After a few breathing cycles, take a deep breath. Let your belly be soft and relaxed, and breathe from your lower abdomen. Repeat -- and use this technique any time you notice that you're tense or worried.

• Anxiety tip #5: Nurture your spirit. Meditation and prayer trigger the relaxation response, helping calm the mind and body. Even the simplest of prayers or affirmations can help you let go of a worry and put everyday problems into perspective.

• Anxiety tip #6: Reframe your thoughts. Free form anxiety often is triggered or accompanied by a litany of negative internal "chatter." The good news is, the brain is an adaptive organ, and it is possible to break out of the negative mode. However, it takes patience and persistence. The first step is to notice when the negative labels start bouncing around in your mind. Simply notice that your thinking is following a particular track, in a nonjudgmental manner. Next, learn how to talk to yourself in a constructive and rational manner. What would you say to a dear and beloved friend in this instance? Try saying the same thing to yourself. This process is a hallmark of cognitive-behavioral therapy.

• Anxiety tip #7: Watch the toxins. Many people use alcohol, caffeine, or nicotine as short-term solutions for their anxiety. The difficulty is that self-medicating with these substances only creates more problems in the long run. Break the cycle. Similarly, be careful with comfort food—this is one of those times that too much of a good thing can make you miserable.

• Anxiety tip #8: Don’t watch the news. Use discretion with television, newspapers, and other sources of news. Of course, it is important to know what’s going on in the world, but our current culture—“all news, all the time,” highlighting the latest disaster in endless replays—can easily trigger or feed anxiety.

• Anxiety tip #9: Don’t worry alone. In the absence of realistic feedback, we often can spin some fairly creative doomsday scenarios. If something is troubling you, get the reassurance and reality checks you need. Consult someone you trust—a friend, family member, or a religious advisor, for instance. Anxiety often diminishes when we share our worries, and practical solutions to problems may emerge in the course of the conversation.

  
  
  
  WHAT IS ANXIETY?
  
  
  
  
  
  
  
  Most people experience feelings of anxiety before an important event such as a big exam, business presentation or first date. Anxiety disorders, however, are illnesses that cause people to feel frightened, distressed and uneasy for no apparent reason. Left untreated, these disorders can dramatically reduce productivity and significantly diminish an individual's quality of life. Fortunately, through research conducted by the National Institute of Mental Health (NIMH), there are effective treatments that can help. NIMH is conducting a national education campaign to increase awareness of these disorders and their treatments.
  
  

  How Common Are Anxiety Disorders?

  
  
  Anxiety disorders are the most common mental illnesses in America: more than 19 million are affected by these debilitating illnesses each year.
  
  
  Anxiety disorders cost the U.S. $46.6 billion in 1990 in direct and indirect costs, nearly one-third of the nation's total mental health bill of $148 billion.
  
  

  What Are the Different Kinds of Anxiety Disorders?

  
  
  1. Panic Disorder: Repeated episodes of intense fear that strike often and without warning. Physical symptoms include chest pain, heart palpitations, shortness of breath, dizziness, abdominal distress, feelings of unreality, and fear of dying. 
  2. Obsessive-Compulsive Disorder: Repeated, unwanted thoughts or compulsive behaviors that seem impossible to stop or control. 
  3. Post-Traumatic Stress Disorder: Persistent symptoms that occur after experiencing a traumatic event such as rape or other criminal assault, war, child abuse, natural disasters or crashes. Nightmares, flashbacks, numbing of emotions, depression and feeling angry, irritable, distracted and being easily startled are common. 
  4. Phobias: Two major types of phobias are specific phobia and social phobia. People with specific phobia experience extreme, disabling, and irrational fear of something that poses little or no actual danger; the fear leads to avoidance of objects or situations and can cause people to limit their lives unnecessarily. People with social phobia have an overwhelming and disabling fear of scrutiny, embarrassment, or humiliation in social situations, which leads to avoidance of many potentially pleasurable and meaningful activities.  
  5. Generalized Anxiety Disorder: Constant, exaggerated worrisome thoughts and tension about everyday routine life events and activities, lasting at least six months. Almost always anticipating the worst even though there is little reason to expect it; accompanied by physical symptoms, such as fatigue, trembling, muscle tension, headache, or nausea.
  
  

  What Are the Treatments for Anxiety Disorders?

  
  
  Treatments have been largely developed through research conducted by NIMH and other research institutions. They are extremely effective and often combine medication or specific types of psychotherapy.
  
  
  More medications are available than ever before to effectively treat anxiety disorders. These include antidepressants or benzodiazepines. If one medication is not effective, others can be tried. New medications are currently being tested or are under development to treat anxiety symptoms.
  
  
  The two most effective forms of psychotherapy used to treat anxiety disorders are behavioral therapy and cognitive-behavioral therapy. Behavioral therapy tries to change actions through techniques such as diaphragmatic breathing or through gradual exposure to what is frightening. In addition to these techniques, cognitive-behavioral therapy teaches patients to understand their thinking patterns so they can react differently to the situations that cause them anxiety.
  
  

  Is it Possible for Anxiety Disorders to Coexist with Other Physical or Emotional Disorders?

  
  
  It is common for an anxiety disorder to accompany another anxiety disorder, or in some cases depression, eating disorders or substance abuse. Anxiety disorders can also coexist with physical disorders. In such instances, these disorders will also need to be treated. Before undergoing any treatment, it is important to have a thorough medical exam to rule out other possible causes.
  
  
  
  
  
  
  
  
  
  
  
  
  
  
  
  
  
  
  
  
  
  
  
  
  
  
  
  
  
  
  
  
  
  

  Panic Disorder Panic disorder is characterized by unexpected and repeated episodes of intense fear accompanied by physical symptoms that may include chest pain, heart palpitations, shortness of breath, dizziness, or abdominal distress. These sensations often mimic symptoms of a heart attack or other life-threatening medical conditions. As a result, the diagnosis of panic disorder is frequently not made until extensive and costly medical procedures fail to provide a correct diagnosis or relief. Many people with panic disorder develop intense anxiety between episodes, worrying when and where the next one will strike. Fortunately, through research supported by the National Institute of Mental Health (NIMH), effective treatments have been developed to help people with panic disorder. How Common Is Panic Disorder? In a given year, 1 to 2% of the U.S. population has panic disorder. Women are twice as likely as men to develop panic disorder. Panic disorder typically strikes in young adulthood. Roughly half of all people who have panic disorder develop the condition before age 24. What Causes Panic Disorder? The exact cause of panic disorder is unknown and is the subject of intense scientific investigation. Possible causes include heredity, other biological factors, stressful life events, and overreacting to normal bodily sensations. Some research suggests panic attacks occur when a “suffocation alarm mechanism” in the brain erroneously fires, falsely reporting that death is imminent. What Treatments Are Available for Panic Disorder? Treatment for panic disorder includes medications and a type of psychotherapy known as cognitive-behavioral therapy, which teaches people how to view panic attacks differently and demonstrates ways to reduce anxiety. NIMH is conducting a large-scale study to evaluate the effectiveness of combining these treatments. Appropriate treatment by an experienced professional can reduce or prevent panic attacks in 70% to 90% of people with panic disorder. Most patients show significant progress after a few weeks of therapy. Relapses may occur, but they can often be effectively treated just like the initial episode. Can People with Panic Disorder Also Have Other Physical and Emotional Illnesses? Research shows that panic disorder can coexist with other disorders, most often depression and substance abuse. About 30% of people with panic disorder use alcohol and 17% use drugs, such as cocaine and marijuana, in unsuccessful attempts to alleviate the anguish and distress caused by their condition. Appropriate diagnosis and treatment of other disorders such as substance abuse or depression are important to successfully treat panic disorder. Approximately 20% of people with panic disorder attempt suicide. It is not unusual for a person with panic disorder to develop phobias about places or situations where panic attacks have occurred, such as in supermarkets or other everyday situations. As the frequency of panic attacks increases, the person often begins to avoid situations where they fear another attack may occur or where help would not be immediately available. This avoidance may eventually develop into agoraphobia, an inability to go beyond known and safe surroundings because of intense fear and anxiety. People with panic disorder may also have irritable bowel syndrome, characterized by intermittent bouts of gastrointestinal cramps and diarrhea or constipation, or a relatively minor heart problem called mitral valve prolapse. In fact, panic disorder often coexists with unexplained medical problems such as chest pain not associated with a heart attack or chronic fatigue.

  
  
  
  
  
  
  
  
  
  
  
  
  
  
  
  
  
  
  
  
  
  
  
  
  
  
  
  
  
  
  
  
  
  
  
  
  
  
  
  
  
  

  Generalized Anxiety Disorder (GAD) is characterized by 6 months or more of chronic, exaggerated worry and tension that is unfounded or much more severe than the normal anxiety most people experience. People with this disorder usually expect the worst; they worry excessively about money, health, family, or work, even when there are no signs of trouble. They are unable to relax and often suffer from insomnia. Many people with GAD also have physical symptoms, such as fatigue, trembling, muscle tension, headaches, irritability, or hot flashes. Fortunately, through research supported by the National Institute of Mental Health (NIMH), effective treatments have been developed to help people with GAD. How Common is GAD? About 3 to 4% of the U.S. population has GAD during the course of a year. GAD most often strikes people in childhood or adolescence, but can begin in adulthood, too. It affects women more often than men.   What Causes GAD? Some research suggests that GAD may run in families, and it may also grow worse during stress. GAD usually begins at an earlier age and symptoms may manifest themselves more slowly than in most other anxiety disorders. What Treatments Are Available for GAD? Treatments for GAD include medications, cognitive-behavioral therapy, relaxation techniques, and biofeedback to control muscle tension. Successful treatment may include a medication called buspirone. Research into the effectiveness of other medications, such as benzodiazapines and antidepressants, is ongoing. Can People with GAD Also Have Other Physical and Emotional Illnesses? Research shows that GAD often coexists with depression, substance abuse, or other anxiety disorders. Other conditions associated with stress, such as irritable bowel syndrome, often accompany GAD. Patients with physical symptoms such as insomnia or headaches should also tell their doctors about their feelings of worry and tension. This will help the patient's health care provider to recognize that the person is suffering from GAD.

  
  
  
  
  
  
  
  
  
  
  
  
  
  
  
  
  
  
  WHAT IS OCD?
  
  
  
  
  
  
  
  People with obsessive-compulsive disorder (OCD) suffer intensely from recurrent, unwanted thoughts (obsessions) or rituals (compulsions), which they feel they cannot control. Rituals such as handwashing, counting, checking, or cleaning are often performed in hope of preventing obsessive thoughts or making them go away. Performing these rituals, however, provides only temporary relief, and not performing them markedly increases anxiety. Left untreated, obsessions and the need to perform rituals can take over a person’s life. OCD is often a chronic, relapsing illness.
  
  
  Fortunately, through research supported by the National Institute of Mental Health (NIMH), effective treatments have been developed to help people with OCD.
  
  
  
  
  
  
  
  
  
  
  
  

  How Common Is OCD?

  
  
  • About 2% of the U.S. population has OCD in a given year.
  • OCD typically begins during adolescence or early childhood; at least one-third of the cases of adult OCD began in childhood.
  • OCD affects men and women equally.
  • OCD cost the U.S. $8.4 billion in 1990 in social and economic losses, nearly 6% of the total mental health bill of $148 billion.
  
  

  What Causes OCD?

  
  
  There is growing evidence that OCD has a neurobiological basis. OCD is no longer attributed to family problems or to attitudes learned in childhood - for example, an inordinate emphasis on cleanliness, or a belief that certain thoughts are dangerous or unacceptable. Instead, the search for causes now focuses on the interaction of neurobiological factors and environmental influences. Brain imaging studies using a technique called positron emission tomography (PET) have compared people with and without OCD. Those with OCD have patterns of brain activity that differ from people with other mental illnesses or people with no mental illness at all. In addition, PET scans show that in patients with OCD, both behavioral therapy and medication produce changes in the caudate nucleus, a part of the brain. This is graphic evidence that both psychotherapy and medication affect the brain.
  
  

  What Treatments Are Available for OCD?

  
  
  Treatments for OCD have been developed through research supported by the NIMH and other research institutions. These treatments, which combine medications and behavioral therapy (a specific type of psychotherapy), are often effective.
  
  
  Several medications have been proven effective in helping people with OCD: clomipramine, fluoxetine, fluvoxamine and paroxetine. If one drug is not effective, others should be tried. A number of other medications are currently being studied.
  
  
  A type of behavioral therapy known as “exposure and response prevention” is very useful for treating OCD. In this approach, a person is deliberately and voluntarily exposed to whatever triggers the obsessive thoughts and then, is taught techniques to avoid performing the compulsive rituals and to deal with the anxiety.
  
  

  Can People With OCD Also Have Other Physical or Emotional Illnesses?

  
  
  OCD is sometimes accompanied by depression, eating disorders, substance abuse, attention deficit hyperactivity disorder, or other anxiety disorders. When a person also has other disorders, OCD is often more difficult to diagnose and treat. Symptoms of OCD can also coexist and may even be part of a spectrum of neurological disorders, such as Tourette’s syndrome. Appropriate diagnosis and treatment of other disorders are important to successful treatment of OCD.  
  
  
  
  
  
  
  
  
  
  
  
  FACTS ABOUT PTSD
  
  
  
  
  
  
  
  Post-traumatic stress disorder (PTSD) is an extremely debilitating condition that  can occur after exposure to a terrifying event or ordeal in which grave physical harm was  threatened or occurred. Traumatic events that can trigger PTSD include violent personal  assaults such as rape or mugging, natural or manmade disasters, car accidents, or military  combat.
  
  
  Most people with PTSD try to avoid any reminders or thoughts of the ordeal. Despite this avoidant behavior, many people with PTSD repeatedly re-experience the ordeal in the form of  flashback episodes, memories, nightmares, or frightening thoughts, especially when they are  exposed to events or objects reminiscent of the trauma. Symptoms of PTSD also include  emotional numbness and sleep disturbances (including insomnia), depression, and irritability or  outbursts of anger. Feelings of intense guilt are also common. PTSD is diagnosed only if these symptoms last more than one month.
  
  
  Fortunately, through research supported by the National Institute of Mental Health (NIMH), effective treatments have been developed to help people with PTSD.
  
  

  How Common Is PTSD?

  
  
  About 4% of the population will experience symptoms of PTSD in a given year.
  
  

  When Does PTSD Strike?

  
  
  PTSD can develop at any age, including childhood. Symptoms of PTSD typically begin within 3  months following a traumatic event, although occasionally symptoms do not begin until years  later. Once PTSD develops, the duration of the illness varies. Some people recover within 6 months while others may suffer much longer.
  
  

  What Treatments Are Available for PTSD?

  
  
   Treatment for PTSD includes cognitive-behavioral therapy, group psychotherapy, and medications  (including antidepressants). Various forms of exposure therapy (such as systemic  desensitization and imaginal flooding) have all been used with PTSD patients. Exposure treatment for PTSD involves repeated reliving of the trauma, under controlled conditions, with  the aim of facilitating the processing of the trauma.
  
  

  Can People with PTSD Also Have Other Physical or Emotional Illnesses?

  
  
  People with PTSD can also have other psychological difficulties, particularly depression, substance abuse, or another anxiety disorder. The likelihood of treatment success is increased when these other conditions are appropriately diagnosed and treated, as well.
  
  
  
  
  
  
  
  
  
  
  
  
  
  
  
  
  
  
  
  
  
  
  
  
  
  
  
  
  
  
  
  
  
  
  
  
  
  
  PHOBIAS
  
  
  Phobias are persistent, irrational fears of certain objects or situations. Phobias occur in several forms; the fear associated with a phobia can focus on a particular object (specific phobia) or be a fear of embarrassment in a public setting (social phobia). People who have phobias are often so overwhelmed by their anxiety that they avoid the feared objects or situations. Specific phobias involve a fear of an object or situation, such as small animals, snakes, closed-in spaces, or flying in an airplane. Social phobia is the fear of being humiliated in a social setting, such as when meeting new people, giving a speech, or talking to the boss. Most people experience these fears with mild to moderate intensity, and the fear passes. For people with social phobia, however, the fear is extremely intrusive and can disrupt normal life, interfering with work or social relationships in varying degrees of severity.
  
  
  Fortunately, through research supported by the National Institute of Mental Health (NIMH), effective treatments have been developed to help people with phobias.
  
  

  How Common Are Phobias?

  
  
  • Approximately 4 to 5% of the U.S. population has one or more clinically significant phobias in a given year.
  • Specific phobias occur in people of all ages. The average age of onset for social phobia is between 15 and 20 years of age, although it can often begin in childhood.
  
  

  What Causes Phobias?

  
  
  Traumatic events often trigger the development of specific phobias, which are slightly more prevalent in women than men. Research shows that social phobia may have a hereditary component and occurs in women and men in equal proportions. However, men may seek treatment for social phobia more frequently than women.
  
  

  What Treatments Are Available for Phobias?

  
  
  Social phobia can be effectively treated with medications including, MAOIs, SSRIs, and high potency benzodiazepines. People with a specific form of social phobia called performance phobia have been helped by drugs called beta blockers. There is no proven drug treatment for specific phobias, but certain medications may help reduce symptoms of anxiety before one faces a phobic situation. A type of cognitive-behavioral therapy known as "exposure therapy" is also a very useful treatment for phobias. It involves helping patients become gradually more comfortable with situations that frighten them. Relaxation and breathing techniques are also helpful.
  
  

  Can People with Phobias Also Have Other Physical and Emotional Illnesses?

  
  
  People with phobias, particularly social phobia, may also have problems with substance abuse. Many people with social or a specific phobia become so anxious that they experience panic attacks, which are intense and unexpected bursts of terror accompanied by physical symptoms. As more situational panic attacks occur, people with phobias may take extreme measures to avoid situations where they fear another attack might happen or where help would not be immediately available. This avoidance, similar to that in many panic disorder patients, may eventually develop into agoraphobia, an inability to go beyond known and safe surroundings because of intense fear and anxiety. Appropriate diagnosis and treatment of other disorders are important to successful treatment of phobias.

10 Best-Ever Anxiety- Management Techniques

There are Effective Alternatives to Medication

by Margaret Wehrenberg

"I don't think I want to live if I have to go on feeling like this." I hear this remark all too often from anxiety sufferers. They say it matter-of-factly or dramatically, but they all feel the same way: if anxiety symptoms are going to rule their lives, then their lives don't seem worth living.

What is it about anxiety that's so horrific that otherwise high-functioning people are frantic to escape it?  The sensations of doom or dread or panic felt by sufferers are truly overwhelming--the very same sensations, in fact, that a person would feel if the worst really were happening. Too often, these, literally, dread-full, sickening sensations drive clients to the instant relief of medication, which is readily available and considered by many insurance companies to be the first line of treatment. And what good doctor would suggest skipping the meds when a suffering patient can get symptomatic relief quickly?

But what clients don't know when they start taking meds is the unacknowledged cost of relying solely on pills: they'll never learn some basic methods that can control or eliminate their symptoms without meds. They never develop the tools for managing the anxiety that, in all likelihood, will turn up again whenever they feel undue stress or go through significant life changes. What they should be told is that the right psychotherapy, which teaches them to control their own anxiety, will offer relief from anxiety in a matter of weeks--about the same amount of time it takes for an SSRI to become effective.

Of course, therapists know that eliminating symptomatology isn't the same as eliminating etiology. Underlying psychological causes or triggers for anxiety, such as those stemming from trauma, aren't the target of management techniques; they require longer-term psychotherapy. However, anxiety-management techniques can offer relief, and offer it very speedily.

The unpleasant symptoms most likely to be helped by medication are the very ones that the 10 best-ever anxiety-management techniques are intended to correct. They fall into three typical clusters:

- the physical arousal that constitutes the terror of panic;

- the "wired" feelings of tension that correlate with being "stressed out" and can include pit-of-the-stomach doom;

- the mental anguish of rumination--a brain that won't stop thinking distressing thoughts.

A therapist armed with methods for addressing these clusters can offer her anxious client the promise of relief for a lifetime, if she knows which of these "10 best" techniques work for which symptoms, and how to use them.

Cluster One: Distressing Physical Arousal

Panic is the physical arousal that sends many clients running for Xanax. Sympathetic arousal causes the heart-thumping, pulse-racing, dizzy, tingly, shortness-of-breath physical symptoms that can come from out of the blue, and are intolerable when not understood. Even high levels of acute anxiety that aren't as intense as outright panic attacks can constitute very painful states of arousal. Physical symptoms of anxiety include constant heightened physical tension in the jaw, neck, and back, as well as an emotional-somatic feeling of doom or dread in the pit of the stomach. The feeling of doom will always set off a mental search for what might be causing it.

Bad as these symptoms are, there are methods that, when followed regularly as lifelong habits, offer tremendous relief.

Method 1: Manage the Body.

Telling anxiety-prone clients to take care of their bodies by eating right, avoiding alcohol, nicotine, sugar, and caffeine, and exercising is a strikingly ordinary "prescription," but not doing these things can undermine the effectiveness of other antianxiety techniques. During the summer before Ellie went off to college, for example, she'd almost eliminated her anxiety by practicing deep, calm breathing and learning to stop her catastrophic thinking. She'd even been able to stop taking the antianxiety medication she'd used for years. But two months after starting college, her panic attacks came roaring back with a vengeance.  She came back to see me, but quickly let me know that she was going to call her psychiatrist for another Xanax prescription. I suggested that, before she made the call, she spend a couple of weeks keeping a "panic profile"--a journal recording when and under what circumstances she suffered from panic attacks.

A couple of weeks later, she came to my office smiling broadly. "I figured it out," she said, grinning as she showed me her panic profile. She'd traced her panic attacks to days after she drank heavily and smoked cigarettes--neither of which had she done over the summer while living in her parents' house. Also, her caffeine use had risen dramatically while at school--to help her wake up for classes after partying at night--and her diet had devolved to pizza and doughnuts. She really didn't want to give up these habits, but keeping the journal had reminded her that her anxiety symptoms are physical, and that calming her body had defused her panic triggers once before. Taking care again to eliminate CATS (caffeine, alcohol, tobacco, sugar + Nutrasweet), Ellie got back on track without returning to meds. The simple rule--manage the body--must remain a first priority throughout treatment for anxiety. Ellie had a major relapse when she let go of routine self-care.

Therapists who remember that humans have bodies as well as minds are much likelier to inquire routinely about ongoing self-care, including sleep and exercise. They're also more willing to help clients overcome their reluctance to follow a self-care routine. A tip to remember for female clients who experience a resurgence of symptoms in spite of the fact that they're managing their body is to consider hormonal changes. Pregnancy, postpartum changes, hysterectomy, and interruptions in cycles may contribute to anxiety. The slow process of menopause, which may begin over a wide range of ages, is another factor to consider. Shifts in thyroid function also contribute to shifts in anxiety. They can occur at any age, and predominate in female clients. Therapists need to be particularly alert to what might be going on in the body when a client who was previously doing well starts having trouble.

Method 2: Breathe.

Ellie and I next reviewed her use of diaphragmatic breathing to ward off the panic. As it turned out, she'd forgotten how helpful breathing had been when we first started working together, and had quit doing it. Now, not only did she suffer again from panic, but she thought it was too powerful to be relieved merely by breathing deeply. She'd begun to panic just thinking about feeling panic. I've often found that when clients say that breathing "doesn't work," it's because they haven't learned to do it correctly. Or once having learned it, they've given it up when they felt better, believing that they no longer needed to do it. By the time they feel anxiety returning, they're convinced that something so simple can't possibly be really effective. Therefore, it's important for therapists to emphasize and reemphasize that breathing will slow down or stop the stress response, if the client will just do it.

The biggest block to making breathing truly helpful is the time it takes to practice it until it becomes an ingrained habit. Most relaxation books teach clients to practice breathing once a day for 10 minutes, but I've never found a client who actually learned how to do it from this one, daily, concentrated dose. I don't teach clients to breathe for lengthy periods until they've practiced it for very short periods many times a day. I ask them to do the conscious, deep breathing for about one minute at a time, 10 to 15 times per day, every time they find themselves waiting for something--the water to boil, the phone to ring, their doctor's appointment, the line to move at the bank. This will eventually help them associate breathing with all of their surroundings and activities. This way, they're more likely to actually remember to breathe when anxiety spikes. Ellie needed a review session in breathing to help her get back on track.

Method 3: Mindful Awareness.

Since the return of her panic attacks, Ellie had also begun to fear that she'd always be afraid. "After all," she said, "I thought I was cured when I went back to school, and now look at me! I'm constantly worried I'll have another panic attack." She'd started to give catastrophic interpretations to every small, physical sensation--essentially creating panic out of ephemeral and unimportant changes in her physical state. A slight chill or a momentary flutter in her stomach was all she needed to start hyperventilating in fear that panic was on its way, which, of course, brought it on. She needed to stop the catastrophic thinking and divert her attention away from her body.

Like most anxious people when they worry, Ellie was thinking about the future and wasn't in the moment. She felt controlled by her body, which required her to be on the lookout for signs of panic. She'd never considered that she could manage her body--and prevent panic--by controlling what she did or didn't pay attention to. But, in fact, by changing her focus, she could diminish the likelihood of another panic attack. A wonderful technique, this simple "mindful awareness" exercise has two simple steps, repeated several times.

1. Clients close their eyes and breathe, noticing the body, how the intake of air feels, how the heart beats, what sensations they have in the gut, etc.

2. With their eyes still closed, clients purposefully shift their awareness away from their bodies to everything they can hear or smell or feel through their skin.

By shifting awareness back and forth several times between what's going on in their bodies and what's going on around them, clients learn in a physical way that they can control what aspects of their world--internal or external--they'll notice. This gives them an internal locus of control, showing them, as Ellie learned, that when they can ignore physical sensations, they can stop making the catastrophic interpretations that actually bring on panic or worry. It's a simple technique, which allows them to feel more in control as they stay mindful of the present.

Cluster Two: Tension, Stress, and Dread Many clients with generalized anxiety disorder (GAD) experience high levels of tension that are physically uncomfortable and compel them to search frantically for the reasons behind their anxiety. They hope they can "solve" whatever problem seems to be causing anxiety and thus relieve its symptoms. But since much of their heightened tension isn't about a real problem, they simply waste time running around their inner maze of self-perpetuating worry. And even if their tension does stem from psychological or neurobiological causes, there are ways to eliminate the symptoms of chronic worry before addressing those dimensions. The following methods are most helpful for diminishing chronic tension. Method 4: Don't Listen When Worry Calls Your Name. Colleen feared I'd  think she was crazy when she said, "It's as if my anxiety has a voice. It calls to me, 'Worry now,' even when there's nothing on my mind. Then I have to go looking for what's wrong." And she was very good at finding something wrong to worry about. An executive who had a lot of irons in the fire, she had no shortage of projects that needed her supervision. On any day, she could worry about whether a report had been correct, or projected figures were accurate, or a contract would generate income for her firm. In describing the voice of worry, she was describing that physical, pit-of-the-stomach sense of doom that comes on for no reason, and then compels an explanation for why it's there. This feeling of dread and tension, experienced by most GAD clients, actually comprises a state of low-grade fear, which can also cause other physical symptoms, like headache, temporo-mandibular joint (TMJ) pain, and ulcers. Few realize that the feeling of dread is just the emotional manifestation of physical tension. This "Don't Listen" method decreases this tension by combining a decision to ignore the voice of worry with a cue for the relaxation state. Early in treatment, GAD clients learn progressive muscle relaxation to get relief. I always teach them how to cue up relaxation several times throughout the day by drawing a breath and remembering how they feel at the end of the relaxation exercise. We usually pair that deeply relaxed state with a color, image, and word to strengthen associations with muscle relaxation and make it easier to cue the sensation at will. We then use that ability to relax to counteract the voice of worry. Clients must first learn that worry is a habit with a neurobiological underpinning. Even when a person isn't particularly worried about anything, an anxiety-prone brain can create a sense of doom, which then causes hypervigilance as the person tries to figure out what's wrong. Colleen smiled with recognition when I said that, when she was in this state, it was as though her brain had gone into radar mode, scanning her horizons for problems to defend against. I asked her to pay attention to the order of events, and she quickly recognized that the dread occurred before she consciously had a worry. "But," she announced, "I always find something that could be causing the doom, so I guess I had a good reason to worry without realizing it." She believed the doom/dread must have a legitimate cause, and was relieved to learn that her need to find the cause (when there really wasn't one) stemmed from a brain function. This cause-seeking part of her brain, triggered by changes in her physiology that made her feel dread, in effect, called out, "Worry now!" To stop listening to that command to worry, I suggested that she say to herself, "It's just my anxious brain firing wrong." This would be the cue for her to begin relaxation breathing, which would stop the physical sensations of dread that trigger the radar.

Method 5: Knowing, Not Showing, Anger.

Anger can be so anxiety-provoking that a client may not allow himself to know he's angry. I often find that clients with GAD have an undetected fear of being angry. Bob was a case in point. He had such a tight grin that his smile was nearly a grimace, and his headaches, tight face muscles, and chronic TMJ problems all suggested he was biting back words that could get him into trouble. There were many arenas of his life in which he felt burdened, such as losing out on a promotion and his wife's chronic inability to spend within their budget, but he genuinely believed he was "putting a good face" on his problems. As with other anxious clients, the acute anxiety was compelling enough to command the therapy time, and it would have been possible to ignore the anger connection. However, as long as anger stays untreated, the anxious client's symptoms will stay in place.

When a client fears anger because of past experience--when she remembers the terrifying rage of a parent, or was severely condemned for showing any anger herself--the very feeling of anger, even though it remains unconscious, can produce anxiety. The key to relieving this kind of anxiety is to decrease the client's sense of tension and stress, while raising the consciousness of anger so that it can be dealt with in therapy. I've found that simply being able to feel and admit to anger in sessions, and to begin working on how to safely express it, diminishes anxiety. I tell clients, "To know you're angry doesn't require you to show you're angry."

The technique is simple. I instruct clients that the next time they're stricken with anxiety, they should immediately sit down and write as many answers as possible to this specific question, "If I were angry, what might I be angry about?"  I tell them to restrict their answers to single words or brief phrases. The hypothetical nature of the question is a key feature, because it doesn't make them feel committed to the idea that they're angry. They may destroy the list or bring it in for discussion, but I ask them to at least tell me their reactions to writing this list. Without fail, this exercise has helped some of my anxious clients begin to get insight into the connection between their anger and their anxiety, which opens the door to deeper levels of psychotherapy that can resolve long-standing anger issues.

Method 6: Have a Little Fun.

Laughing is a great way to increase good feelings and discharge tension. The problem for anxious clients is that they take life so seriously that they stop creating fun in their lives, and they  stop experiencing life's humorous moments. Everything becomes a potential problem, rather than a way to feel joy or delight.

Margaret was a witty woman, whose humor was self-deprecating. A high-level executive who typically worked 12- to 14-hour days, she'd stopped laughing or planning fun weekends about two promotions back. Her husband rarely saw her on weeknights, and on Saturday and Sunday, she typically told him she was just "going to run over to the office for a little while"--anywhere from 3 to 7 hours. When I asked her to make a list of what she did for fun, she was stymied. Other than having a drink with friends after work, her list of enjoyable activities was almost nonexistent.

Getting in touch with fun and play isn't easy for the serious, tense worrier. I've often found, however, that playing with a child will get a person laughing, so I asked her to spend some time with her young nieces. She agreed, and noticed that she felt more relaxed after being with them for an afternoon. Then I asked her to watch for any impulse to do something "just because," without any particular agenda in mind. When I saw her next, she seemed transformed. She said, "I had an impulse to stop for an ice-cream cone, so I just went out and got it. I don't know when the last time was that I felt like doing something and just did it--no worries about whether everyone else had a cone or whether I should wait till later. It was fun!" Over time, listening to her inner wishes helped Margaret feel that there was a reservoir of pleasure in life that she'd been denying herself, and she began to experiment with giving herself the time to find it.

But Margaret needed to rediscover what she liked after years of ignoring pleasure. For a time, our therapy goal was simply to relearn what she had fun doing. Fun-starved clients sometimes need a "prescription," like "Take two hours of comedy club and mix with a special friend, once a week" or "Plan one weekend out of town with your husband every two months." Not surprisingly, tightly wired workaholics initially need to make fun a serious goal of treatment, something to be pursued with some of the same doggedness they put into work.  But once they actually find themselves laughing and enjoying themselves, they become less tightly wired, less dogged, and more carefree. Laughter itself is one of the best "medications" of all for tension and anxiety.

Cluster Three: The Mental Anguish of Rumination

The final methods are those that deal with the difficult problem of a brain that won't stop thinking about distressing thoughts. Worries predominate in social phobia, GAD, and other kinds of anxiety, and continual rumination can create nausea and tension, destroying every good thing in life. A metaphor drawn from nature for this kind of worry would be kudzu, the nearly unkillable plant that proliferates wildly, suffocating every other form of life, just as continual worry suffocates clients' mental and emotional lives.

I don't believe rumination is caused by deep-seated conflict in the way anger-anxiety might be; I think it's almost entirely a neurobiologically driven feature of anxiety. What clients usually worry about--often ordinary, day-to-day concerns--is less important than the omnipresence of the worry. Their brains keep the worry humming along in the background, generating tension or sick feelings, destroying concentration, and diminishing the capacity to pay attention to the good things in life. Seeking reassurance or trying to solve the problem they're worrying about becomes their sole mental activity, obscuring the landscape of their lives. Nor can ruminators ever get enough reassurance to stop worrying altogether. If one worry is resolved, another pops right up--there's always a fresh "worry du jour."

Therapy with these clients shouldn't focus on any specific worry, but rather on the act of worrying itself. If a ruminating brain is like an engine stuck in gear and overheating, then slowing or stopping it gives it a chance to cool off. The more rumination is interrupted, the less likely it'll be to continue. The following methods are the most effective in eliminating rumination.

Method 7: Turning It Off.

Peter's rumination was the bane of his existence. A mile-a-minute supersalesman with remarkable drive, he had a capacity to fret that could wear out a less energetic person. His mind traveled from one possible problem to another like a pinball that never comes to rest. Ruminating worry preoccupied him so much that he couldn't enjoy being with his children or relax before going to sleep--his last conscious awareness at night was of worry.

In therapy, he had a hard time focusing on just one issue at a time; one worry just reminded him of another and another after that. Before addressing the psychological underpinnings of worry in his life, we needed to find a way for Peter to cool down his brain and halt the steady flow of rumination for a while.

From Eugene Gendlin's Focusing method, I've borrowed the concept of "clearing space" to turn off and quiet the ruminative mind. I ask the client to sit quietly with eyes closed and focus on an image of an open container ready to receive every issue on his or her mind. She's then instructed to see and name each issue or worry, and imagine putting it into the container. When no more issues come to mind, I suggest that the client mentally "put a lid" on the container and place it on a shelf or in some other out of the way place until she needs to go back to get something from it. Once the jar is on the shelf, the client invites into the space left in her mind whatever is the most important current thought or feeling. Perhaps she's at the office and needs to think about a work-related issue, or she needs to shop and should plan what she'll buy, or she's with friends and wants to focus on what they're saying. At night, right before sleep, the client is asked to invite a peaceful thought to focus on while drifting off.

Peter is a man who prefers tangible tools to metaphorical ones, so when he was at home, I suggested that instead of using imagery, he make a written list of the issues he couldn't turn off and put the list in a desk drawer to wait for him overnight, or even place it in his freezer to help him "chill out." Any tangible technique is fine, such as Al Anon's idea of a "God Box" to hold slips of paper, each with a worry written down that the client is turning over to God. The goal of "turning it off" is to give the ruminative mind a chance to rest and calm down.

Method 8: Persistent Interruption of Rumination.

Ruminative worry has a life of its own, consistently interfering with every other thought in your client's mind. Thought-stopping/ thought-replacing is the most effective cognitive-therapy technique for interrupting chronic rumination, but I find the key to making it work is persistence . Clients very quickly pick up on the technique itself, but they're always shocked by how rumination can subvert all their good efforts, and by how persistently they have to keep at it to succeed. I've had clients come back and say the technique didn't work, because they'd tried it 20 to 30 times in a day and they still were ruminating. I tell them that they must do it every time they catch themselves ruminating, even if it is 1,000 times a day or more! That's what I mean by persistence.

Darla is a good example. She was a self-described worrywart before she got cancer, but after her diagnosis, her anxiety zoomed out of control. Although treatment was successful and she'd been in remission for some time, she still had constant, negative, racing thoughts about whether her cancer would recur. A really hard worker in therapy, she did every method I suggested, and was ready to use thought-stopping to interrupt her ruminations about cancer. "Remember," I told her, "winning this game is about persistence. Do the thought-stopping exercise every single time you find yourself worrying, no matter how many times you have to do it."

At the next session, she reported her success--she really had radically cut back the amount of worrying she was doing. But it worked only because I'd warned her about how persistent she'd have to be. "When you told me I'd have to thought-stop every time, even if it was 1,000 times a day," she said, "I thought you were kidding. If you hadn't warned me, I'd have given up in despair after about 100 times, thinking it would never work for me. Since you said 1,000, I figured I'd better stay the course. After a couple of days, it got markedly better." Rumination is persistent, and the only way to beat it at its own game, so to speak, is to be even more persisten

Method 9: Worry Well, But Only Once. Some worries just have to be faced head-on, and worrying about them the right way can help eliminate secondary, unnecessary worrying. Connie knew that her next medical results were going to tell the story of whether she needed surgery. Although there's always a level of legitimate worry about any medical problem, some medical conditions, like high thyroid, create anxiety symptomatology. Connie's medical problems weren't causing the anxiety symptoms, but her anxiety about her condition was getting in the way of her medical recovery. She called the doctor's office repeatedly, until the doctor said she'd fire Connie if she got one more phone call before the test results came in. Connie was out of control with worry, so we tried out a method that actually had her worry, but worry well--and only once. Here's how that works. The client must: (1) worry through all the issues; (2) do anything that must be done at the present time; (3) set a time when it'll be necessary to think about the worry again; (4) write that time on a calendar; and (5) whenever the thought pops up again, say, "Stop! I already worried!" and divert her thoughts as quickly as possible to another activity. Connie and I set a 10-minute time limit on our worry session, and then together thought through all the possible ramifications of a positive test result. She covered things such as "Who'll watch the cat while I'm in the hospital?" "Will I have to miss too many days of work?" "Will I need a ride home?" We covered everything from the mundane to the serious, if unlikely, "What if I die while in surgery?" It's critical to this method to cover all the bases, but 10 minutes, surprisingly, is an adequate amount of time in which to do that. At the end of the worry period, Connie agreed that she had no other worries related to the surgery, so we set a time at which she thought she'd need to think about the problem again. We agreed that the next time she should let the possibility of surgery cross her mind was when the doctor's office called. Until that moment, any thought would be counterproductive. She wrote in her PDA that she could worry again at 4 p.m. on Tuesday afternoon, by which time the results would be in and the doctor had promised to call. If she hadn't heard at that point, then she could start worrying and call the doctor's office. Having worried well, we moved to the "Only Once" part of the method. She then practiced, "Stop It! I already worried!" and we made a list she could carry around with her that enumerated some distractions to use. While this may sound trite, her brain believed her when she said she'd already worried, because it was true.

Method 10: Learn to Plan Instead of Worry.

A big difference between planning and worrying is that a good plan doesn't need constant review. An anxious brain, however, will reconsider a plan over and over to be sure it's the right plan. This is all just ruminating worry disguising itself as making a plan.

Clients who ruminate about a worry always try to get rid of it by seeking the reassurance that it's unfounded. They believe that if they get the right kind of solution to their problem--the right piece of information or the best reassurance--they'll then be rid of the worry once and for all. They want to be absolutely sure, for example, that a minor mistake they made at work won't result in their being fired. In reality, however, a ruminating brain will simply find some flaw in the most fail-safe reassurance and set the client off on the track of seeking an even better one.

One good way to get out of the reassurance trap is to use the fundamentals of planning. This simple but often overlooked skill can make a big difference in calming a ruminative mind. I teach people how to replace worrying with planning. For most, this includes: (1) concretely identifying a problem; (2) listing the problem-solving options; (3) picking one of the options; and (4) writing out a plan of action. To be successful with this approach, clients must also have learned to apply the thought-stopping/thought-replacing tools, or they'll turn planning into endless cycles of replanning.

After they make a plan, ruminating clients will feel better for a few minutes and then start "reviewing the plan"--a standard mental trick of their anxiety disorder. The rumination makes them feel overwhelmed, which triggers their desire for reassurance. But when they've actually made the plan, they can use the fact that they have the plan as a concrete reassurance to prevent the round-robin of ruminative replanning. The plan becomes part of the thought-stopping statement, "Stop! I have a plan!" It also helps stop endless reassurance-seeking, because it provides written solutions even to problems the ruminator considered hopelessly complex.

For example, if Connie, who'd worried well about surgery, found out she did have to have the surgery, she could write out the plan to get ready. The new plan would cover all the issues she'd identified in her worry session, from finding a catsitter to writing a living will. She'd put completion dates in for each step and cross off the items as she did them until the day of the surgery. Then, each time she needed reassurance, the concrete evidence that she had a good plan would enable her to go on to some other thought or activity.

While these techniques aren't complicated or technically difficult to teach, they do require patience and determination from both therapist and client. For best results, they also demand clinical knowledge of how and why they work, and with what sorts of issues; they can't simply be used as all-purpose applications, good for anybody in any circumstance. But the rewards of teaching people how to use these deceptively simple, undramatic, and ungimmicky methods are great. While clients in this culture have been indoctrinated to want and expect instantaneous relief from their discomfort at the pop of a pill, we can show them we have something better to offer. We can give people a lasting sense of their own power and competence by helping them learn to work actively with their own symptoms, to conquer anxiety through their own efforts--and do this in a nonmanipulative, respectful, engaging way. People like learning that they have some control over their feelings; it gives them more self-confidence to know they're not the slaves of physiological arousal or runaway mental patterns. And what we teach them is like playing the piano or riding a bicycle: they own it for life; it becomes a part of their human repertoire. What medication can make that claim? Margaret Wehrenberg, Psy.D., has been in private practice as a psychologist and addictions counselor for more than 20 years. She also specializes in trauma and anxiety, working with adolescents and adults. She's the cofounder of the Reflex Delay Institute, and the author of Stress Solutions: Effective Strategies to Eliminate Your Stress. Contact: drmw116@aol.com. Letters to the Editor about this article may be e-mailed to letters@psychnetworker.org.

Love is an enemy of fear. So is gratitude. “Be anxious for nothing but in all things, by prayer and supplication WITH THANKSGIVING, let your requests be made known to God; and the PEACE of God that surpasses understanding will keep your hearts and minds in Christ Jesus.” I think it may be impossible to be thankful and fearful simultaneously. Here’s a formula that has helped many of my clients deal with fear/anxiety:
Face, don’t Flee, and
Float, don’t Fight.
You can’t get away from something going on inside your own skin: so don’t try. Turn toward it in the power of His Spirit and watch it shrink away from you.
The fight against fear is a manifestation of the fear itself. When we “Float” in our Faith in Christ, fear evaporates or passes like an emotional wave passing through our heart. We are always left standing on the firm, unshakable foundation of God-with-us.