Anxiety Treatment: An Overview of Symptoms, Disorders, and Effective Counseling Options
By Elizabeth Klaers, MSW, LSW
Everyone experiences anxiety at some point in their life. Whether going on that first date, driving on an ice-covered road, or facing a big deadline at work, occasional nervousness or fear is a natural response to stressful situations in life. In most cases it is actually a helpful response, prompting a more alert and focused state of mind assisting us in navigating a challenging or even dangerous situation.
For some, anxiety becomes extreme and relentless. Habitual nervousness and worry and may be a sign of an anxiety disorder. Anxiety has a broad range of symptoms that may manifest in the body, mind, or mood including feelings of apprehension, sense of impending danger or panic, flight of thoughts, increased heart rate, rapid breathing, trembling, exhaustion, or insomnia.
If you or your child suffer from symptoms of anxiety, you are not alone – in the U.S. over 40 million adults suffer from anxiety (18 percent of the U.S. population). Anxiety manifests in a myriad of ways and several types of anxiety disorders exist, including:
Generalized Anxiety Disorder (GAD) symptoms include a persistent feeling of dread or constant restlessness that distract one from daily activities. Additionally, GAD often includes physical symptoms that include upset stomach, exhaustion, and insomnia.
Anxiety attacks (Panic Disorder) manifests suddenly and can cause significant fear, apprehension, and terror as well the added fear of future panic attacks. Panic attacks involve intense physical symptoms including tingling sensations, weakness in the body, muscle tightening, difficulty breathing, chest pain, and digestive discomfort.
Post-traumatic stress disorder (PTSD) can be described as a severe anxiety disorder which often occurs in the aftermath of a traumatic or life threatening event. Symptoms include flashbacks or nightmares, emotional numbness or substance abuse, avoidance of trauma-related reminders (people, places, conversations, or situations), social withdrawal, difficulty sleeping, or avoiding reminders of the trauma.
Obsessive Compulsive Disorder (OCD) is characterized by unwanted thoughts (obsessions) or behaviors (compulsions) that are believed to be unstoppable. One may try to rid themselves of thoughts by performing actions but find the action does not help and often worsens the cycle of obsessive thought and compulsive action.
Social Phobia involves fear of social situations to the extent it disrupts one’s life. People with social phobia perceive social situations as likely painful and highly distressing. It is common for someone with social phobia to avoid social situations altogether.
While the symptoms can feel frightening and leave one with a sense of helplessness there is hope. Anxiety disorders are treatable and the majority of those who seek treatment improve considerably.
Depending on the type of anxiety one is experiencing, counseling offers effective approaches to managing symptoms and in some cases resolving symptoms. Effective anxiety treatments often address the underlying factors contributing to recurring symptoms of anxiety and teach skills that can be used in daily life. Some counseling approaches include: Cognitive Behavioral Therapy (CBT), Mindfulness Based approaches, and Dialectical Behavioral Therapy (DBT). Supportive therapy may include education, family therapy, play therapy, group therapy, or support groups. This is meant to serve as sampling of a few possible options for anxiety treatment.
Cognitive Behavioral Therapy
CBT is a well-researched approach to treating anxiety disorders. It works on the premise that one’s feelings and behaviors are a result of the thoughts or reactions one has to a given experience, event, or situation.
For example, imagine you are driving and approaching an intersection. The car in front of you remains stopped at the intersection for a few seconds longer than usual. You may think, “Hey, this guy isn’t paying attention, he doesn’t care about anybody else!” and move to sound your horn. You may feel your body tensing as you squeeze the wheel tightly or, as the seconds go by, you may begin feeling worried about being late to work as your heart rate increases. Just as you are about to lay on the horn, you see two pedestrians come into view as they cross the street in front the car ahead of you. Despite your thoughts, it wasn’t about you.
Therapists using CBT will work collabrotively to assist you in ending vicious cycles of negative thinking, feeling and behavior. It is challenging work and requires observing one’s own patterns of thought, learning one’s triggers, and practicing new skills. It is a short term treatment that, practiced consistently, will have long-lasting results.
Mindfulness Based Approaches
The paradigm of mindfulness assumes that when we attempt to avoid pain we compound it. Rather than attempting to avoid difficult feelings, mindfulness is a practice of changing how one relates to the experience at hand, here and now in the present moment.
It is commonplace to be inundated with external and internal stimulation in our busy lives. When going about daily tasks we often give experiences only partial attention. Mindfulness is the practice of giving one object, sensation, or act our focused attention. For example, one can gently focus on the breath and the sensation of the chest rising with the inhale and falling with the exhale.
Mindfulness approaches in counseling may include the therapist using verbal cues to guide one in maintaining attention on movements, posture, and breath. It involves being a witness to one’s sensations, feelings, and thoughts and how they manifest, move, and evolve from moment to moment. Awareness exercises can help a person develop self-compassion, a necessary element to working with fear.
Like other types of counseling, mindfulness based approaches involve exposure to the discomfort and fear one is experiencing. Exposure, challenging though it may be, it is a key component in any effective anxiety treatment.
Dialectical Behavioral Therapy (DBT), a combination of cognitive behavioral and mindfulness practice, is used in helping people learn how to manage difficult or overwhelming emotions. DBT treatment involves teaching skills that include mindfulness, acceptance and self-compassion, interpersonal effectiveness, and emotional regulation.
DBT may be conducted in individual therapy, skills classes, and phone coaching. It is designed to teach one how to move through painful or frightening feelings and accept discomfort when needed, while gaining the ability to make positive choices in life.
An important factor to consider when treating anxiety is the quality of one’s social network, especially close family and friends. Being well resourced with strong social support can positively impact successful outcomes. When family members participate in treatment, they learn about how anxiety impacts their loved one and how to best support them in the healing process. Studies show that when therapists utilize CBT in family therapy, anxiety symptoms in both child and parent are significantly reduced.
When it comes to development we know that repeated interactions between children and infants and their primary caregivers is the key element in the formation of personality. In situations where parents suffer emotional challenges and anxiety, their child may be at risk for experiencing anxiety and subsequent social challenges. Reaching out for support can be a gift to the entire family.
Play Therapy is a well established discipline based on specific psychological theories including human development. Therapeutic play provides a child with a safe, confidential and caring environment in which the child communicates through their primary language – play. A therapist may provide strategies that will help the child cope with difficulties and can result in an increase in self-confidence and sense of empowerment. Studies show that over 70 percent of children referred to Play Therapy achieve positive results. Additionally, we know that when child therapists use CBT in Child Therapy it often results in positive outcomes for children with anxiety.
Other ways to support treatment include lifestyle changes involving diet, regular exercise, and relaxation techniques. When learning to manage anxiety, these activities often contribute to positive results and elicit a sense of empowerment.
Remember that some anxiousness is normal and even helpful. When anxiousness interferes with daily life, it would be wise to get some professional advice. A skilled therapist can provide complete and individualized care in the treatment of anxiety. Please consult a trained professional to get more information about your specific situation and symptoms.
Elizabeth Klaers is a therapist who works with individuals and families, both adults and young children. In addition to her private practice in Boulder, Elizabeth is a ProBono Therapist and Development Extern at Maria Droste Counseling Center.