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Anxiety

Updated: Oct 22, 2021

Anxiety is one of the most common reasons people come to see me.


Anxiety feels very physical and this can add an extra layer of worry. Sometimes it is a fear of having something medically wrong, because the psychical feeling of anxiety is so strong. Sometimes people say the worst part is that it might be visible to others, for example with sweating, shaking or blushing.


There are many ways to work with anxiety disorders, and it depends on finding the root cause. Once we have found the root cause I will work out the best approach.


Whichever model of treatment we use, it’s important to remember that anxiety is built into our body for good reason – to keep us alive. Feeling anxiety is perfectly normal- but we want it to show up in appropriate amounts, in situations where we really need it, not the sort of horrible free-flowing anxiety that wakes you with a start a 3am.


The aim of treatment is to get balance back. A therapy plan involves developing skills to handle the genuinely difficult and stressful times in life and to break the cycle of unnecessary anxiety.


In addition to considering what factors from the past might have caused more anxiety in the here and now, we can also work on modifying the two sides of this equation:



Treatment in CBT works on reducing your tendency to overestimate the probability that things will go badly, and increase your perception that you can handle whatever happens. An example of this is adjusting your perspective:


e.g. When something stressful is happening and your mind is running into the future imagining how much worse it could get, you can:

  • Remember the 3 P's ....

  • Its not permanent. Remind yourself that ‘this is not going to last forever.’ Remember that every moment is constantly changing. No matter how bad a day feels, it will feel different tomorrow.

  • It's not pervasive. Remind yourself that whatever is happening for you, it’s not pervasive, and it’s not affecting everything in your life. Here it is good to take a helicopter view. The issue is still there but add in all the other things around it too to develop a more helpful perspective.

  • Its not personal. Very few of the things that cause stress and anxiety day to day are deeply personal. If it is, then there are still ways to manage the situation in a way that is helpful to you. Talking to others can help reign-in anxiety when you are struggling to see a bigger picture or appreciate your resources to cope. Likewise, bring a compassionate and friendly attitude to your suffering. Give yourself the same kindness you would give a loved one.

In CBT we encourage finding different perspectives. Your mind gives you one input. If it’s not working for you just notice that it's just one idea, it's one opinion, and you can find one that works better for you.


Worry-time. I also really like teaching ‘worry time’ when anxious thoughts and insistent worries are intrusive. In the same way that college professors keep office hours for students to come and speak with them, your worries need some ring-fenced office hours so they are not intrusive into your day to day life. This technique is helpful so you can learn the “not right now” approach for interruptions when they come knocking outside 'office hours'. It can also help with sleep as part of a programme of other interventions.


EMDR

EMDR was originally developed for trauma but practitioners are now seeing its wide-ranging results with a wide range of issues, including panic and anxiety, amongst others. When we track back from anxiety in the here and now it is often connected to events from the past.


In EMDR we work with anxiety as if the reactivity we experience today is a sort of ‘electrical storm’ or over-sensitive alarm, being generated by past events. In these cases the ripple effects of past events are impacting your tolerance for situations in the present day. This is because of the networks of memory and association linking everything together. Once the meaning and interpretation of past events is changed, the anxiety is no longer triggered by associations in the here and now.


EMDR also overlaps in some areas with hypnotherapy. These approaches can work well with triggers for the nervous system. The work in the past and into the future helping to build confidence to handle life more calmly. After all – the reason most people seek therapy is to develop the skills to have meaningful rewarding relationships, to feel comfortable with ourselves and our life, to go to bed feeling proud of the choices we made and to have fulfillment. Equally, many people self-medicate to try and get rid of anxiety. Anxiety can end up leading to unhelpful addictions, over-compensations and unhelpful habits that cause people to unintentionally drift away from what matters most.



Anxiety about future events can also be worked with using EMDR.

I have noticed panic attacks and social anxiety respond extremely well to EMDR because people can remember key events which are related to the problems today and which fuel further anticipatory anxiety about the future.

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